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Objectives To investigate the association between the degree of patient dehydration on presentation with diabetic ketoacidosis (DKA) and clinical and laboratory parameters obtained on admission. Design Prospective descriptive study. Setting A tertiary care children's hospital. Patients Thirty-nine paediatric patients (1 month-16 years) presenting with 42 episodes of DKA. Intervention Clinical and biochemical variables were collected on admission. Dehydration was calculated by measuring acute changes in body weight during the period of illness. All patients were treated according to a previously established protocol. Main outcome measures Magnitude of dehydration, defined as % loss of body weight (LBW), was determined by the difference in body weight obtained at presentation and at discharge. The relationship between the magnitude of dehydration and the clinical assessment and biochemical parameters was examined. Results The median (25th-75th centiles) magnitude of dehydration at presentation was 5.7% (3.8-8.3%) (mean±SD 6.8±5%). Neither the initial clinical assessment nor the comprehensive biochemical profile at admission correlated with the magnitude of dehydration. Despite considerable variation in the degree of dehydration and biochemical disequilibrium, all patients recovered from DKA within 24 h with a standardised therapeutic approach. Furthermore, the rapidity of patient recovery did not correlate with the magnitude of dehydration on presentation or the amount of fluid administered (median (25th-75th centiles) 48.8 ml/kg (38.5-60.3)) in the first 12 h. Conclusion The magnitude of dehydration in DKA is not reflected by either clinical or biochemical parameters. These findings need confirmation in larger studies. [ABSTRACT FROM AUTHOR]

We report the successful management of a five-year-old child with severe diabetic ketoacidosis with dehydration, who received his initial resuscitative fluids and a continuous infusion of insulin via an intraosseous needle. The patient had presented to a remote community hospital and intravenous access could not be gained. The correction of hyperglycaemia and metabolic acidaemia was achieved at a rate comparable to intravenous therapy. No complications were observed. Although intraosseous access is well described in paediatric resuscitation guidelines, it is not mentioned in International Diabetes Society guidelines for the management of diabetic ketoacidosis. Alternatives to intravenous administration of insulin delivery recommended in such guidelines, such as the subcutaneous or intramuscular routes, may be less appropriate than the intraosseous route. This route can also allow resuscitation fluids and other drugs to be reliably administered in children with diabetic ketoacidosis and severe dehydration where intravenous access can not be attained. We suggest that the potential role of intraosseous access, when intravenous access can not be obtained, should be considered when management guidelines for paediatric diabetic ketoacidosis with dehydration are reviewed. [ABSTRACT FROM AUTHOR]

Per and polyfluoroalkyl substances (PFAS) are ubiquitous in the indoor environment, resulting in indoor exposure. However, a dearth of concurrent indoor multi-compartment PFAS measurements, including air, has limited our understanding of the contributions of each exposure pathway to residential PFAS exposure. As part of the Indoor PFAS Assessment (IPA) Campaign, we measured 35 neutral and ionic PFAS in air, settled dust, drinking water, clothing, and on surfaces in 11 North Carolina homes. Ionic and neutral PFAS measurements reported previously and ionic PFAS measurements reported herein for drinking water (1.4-34.1 ng L -1 ), dust (202-1036 ng g -1 ), and surfaces (4.1 × 10 -4 -1.7 × 10 -2 ng cm -2 ) were used to conduct a residential indoor PFAS exposure assessment. We considered inhalation of air, ingestion of drinking water and dust, mouthing of clothing (children only), and transdermal uptake from contact with dust, air, and surfaces. Average intake rates were estimated to be 3.6 ng kg -1 per day (adults) and 12.4 ng kg -1 per day (2 year-old), with neutral PFAS contributing over 80% total PFAS intake. Excluding dietary ingestion, which was not measured, inhalation contributed over 65% of PFAS intake and was dominated by neutral PFAS because fluorotelomer alcohol (FTOH) concentrations in air were several orders of magnitude greater than ionic PFAS concentrations. Perfluorooctanoic acid (PFOA) intake was 6.1 × 10 -2 ng kg -1 per day (adults) and 1.5 × 10 -1 ng kg -1 per day (2 year-old), and biotransformation of 8 : 2 FTOH to PFOA increased this PFOA body burden by 14% (adults) and 17% (2 year-old), suggesting inhalation may also be a meaningful contributor to ionic PFAS exposure through biotransformation.

The distribution and fate of per- and polyfluoroalkyl substances (PFAS) in homes are not well understood. To address this, we measured nine neutral PFAS in dust, airborne particles, dryer lint, and on heating and air conditioning (HAC) filters in 11 homes in North Carolina as part of the Indoor PFAS Assessment (IPA) Campaign and compared them with concurrently collected gas and cloth measurements. Fluorotelomer alcohols (FTOHs) contributed most (≥75%) to total (∑) measured neutral PFAS concentrations in dust, HAC filter, and dryer lint samples, with mean ∑(FTOH) concentrations of 207 ng/g, 549 ng/g, and 84 ng/g, respectively. In particles, perfluorooctane sulfonamidoethanols (FOSEs) dominated, with a mean ∑(FOSE) concentration of 0.28 ng/m 3 or 75,467 ng/g. For FTOHs and FOSEs, resulting mean dust-air, HAC filter-air, dryer lint-air and particle-air partition coefficients in units of log(m 3 /μg) ranged (across species) from -5.1 to -3.6, -4.9 to -3.5, -5.4 to -4.1, and -3.2 to -0.78, respectively. We estimate that cloth, gas phase, and HAC filters are the largest reservoirs for FTOHs, while cloth, HAC filters, and dust are the largest reservoirs for FOSEs. Release rates of neutral PFAS from homes to the outdoor environment are reported.

Per- and polyfluoroalkyl substances (PFAS) are prevalent in consumer products used indoors. However, few measurements of ionic PFAS exist for indoor air. We analyzed samples collected on PM 2.5 quartz fiber filters (QFFs) in 11 North Carolina homes 1-3 times in living rooms (two QFFs in series), and immediately outside each home (single QFF), for 26 ionic PFAS as part of the 9 months Indoor PFAS Assessment (IPA) Campaign. All targeted PFAS, except for PFDS and 8:2 monoPAP, were detected indoors. PFBA, PFHpA, PFHxA, PFOA, PFOS, and 6:2 diPAP were detected in >50% of indoor samples. PFHxA, PFOA, and PFOS had the highest detection frequency (DF = 80%; medians = 0.5-0.7 pg m -3 ), while median PFBA concentrations (3.6 pg m -3 ; DF = 67%) were highest indoors. Residential indoor air concentrations (sum of measured PFAS) were, on average, 3.4 times higher than residential outdoor air concentrations, and an order of magnitude higher than regional background concentrations. Indoor-to-outdoor emission rate estimates suggest that emissions from single unit homes could be a meaningful contributor to PFBA, PFOA, and PFOS emissions in populated areas far from major point sources. Backup QFFs were observed to adsorb some targeted PFAS from the gas-phase, making reported values upper-bounds for particle-phase and lower-bounds for total air (gas plus particle) concentrations. We found that higher concentrations of carbonaceous aerosol were associated with a shift in partitioning of short chain PFCAs and long chain PFSAs toward the particle phase.

Indoor surfaces are coated with organic films that modulate thermodynamic interactions between the surfaces and room air. Recently published models can simulate film formation and growth via gas-surface partitioning, but none have statistically investigated film composition. The Indoor Model of Aerosols, Gases, Emissions, and Surfaces (IMAGES) was used here to simulate ten years of nonreactive film growth upon impervious indoor surfaces within a Monte Carlo procedure representing a sub-set of North American residential buildings. Film composition was resolved into categories reflecting indoor aerosol (gas + particle phases) factors from three sources: outdoor-originating, indoor-emitted, and indoor-generated secondary organic material. In addition to gas-to-film partitioning, particle deposition was modeled as a vector for organics to enter films, and it was responsible for a majority of the film mass after ∼1000 days of growth for the median simulation and is likely the main source of LVOCs within films. Therefore, the organic aerosol factor possessing the most SVOCs contributes most strongly to the composition of early films, but as the film ages, films become more dominated by the factor with the highest particle concentration. Indoor-emitted organics ( e.g. from cooking) often constituted at least a plurality of the simulated mass in developed films, but indoor environments are diverse enough that any major organic material source could be the majority contributor to film mass, depending on building characteristics and indoor activities. A sensitivity analysis suggests that rapid film growth is most likely in both newer, more air-tight homes and older homes near primary pollution sources.

Models and laboratory studies suggest that everyday clothing influences the transdermal uptake of semivolatile organic compounds, including phthalate plasticizers, from indoor environments. However, this effect has not been documented in environmental exposure settings. In this pilot study, we quantified daily excretion of 17 urinary metabolites (μg/day) for phthalates and phthalate alternatives in nine participants during 5 days. On Day 0, baseline daily excretion was determined in participants' urine. Starting on Day 1, participants refrained from eating phthalate-heavy foods and using personal care products. On Days 3 and 4, participants wore precleaned clothing as an exposure intervention. We observed a reduction in the daily excretion of phthalates during the intervention; mono- n -butyl phthalate, monoisobutyl phthalate (MiBP), and monobenzyl phthalate were significantly reduced by 35, 38, and 56%, respectively. Summed metabolites of di(2-ethylhexyl)phthalate (DEHP) were also reduced (27%; not statistically significant). A similar reduction among phthalate alternatives was not observed. The daily excretion of MiBP during the nonintervention period strongly correlated with indoor air concentrations of diisobutyl phthalate (DiBP), suggesting that inhalation and transdermal uptake of DiBP from the air in homes are dominant exposure pathways. The results indicate that precleaned clothing can significantly reduce environmental exposure to phthalates and phthalate alternatives.

Wildfires are increasing in frequency, raising concerns that smoke can permeate indoor environments and expose people to chemical air contaminants. To study smoke transformations in indoor environments and evaluate mitigation strategies, we added smoke to a test house. Many volatile organic compounds (VOCs) persisted days following the smoke injection, providing a longer-term exposure pathway for humans. Two time scales control smoke VOC partitioning: a faster one (1.0 to 5.2 hours) that describes the time to reach equilibrium between adsorption and desorption processes and a slower one (4.8 to 21.2 hours) that describes the time for indoor ventilation to overtake adsorption-desorption equilibria in controlling the air concentration. These rates imply that vapor pressure controls partitioning behavior and that house ventilation plays a minor role in removing smoke VOCs. However, surface cleaning activities (vacuuming, mopping, and dusting) physically removed surface reservoirs and thus reduced indoor smoke VOC concentrations more effectively than portable air cleaners and more persistently than window opening.

Partitioning of per- and polyfluoroalkyl substances (PFAS) to indoor materials, including clothing, may prolong the residence time of PFAS indoors and contribute to exposure. During the Indoor PFAS Assessment (IPA) Campaign, we measured concentrations of nine neutral PFAS in air and cotton cloth in 11 homes in North Carolina, for up to 9 months. Fluorotelomer alcohols (i.e., 6:2 FTOH, 8:2 FTOH, and 10:2 FTOH) are the dominant target species in indoor air, with concentrations ranging from 1.8 to 49 ng m - 3 , 1.2 to 53 ng m - 3 , and 0.21 to 5.7 ng m - 3 , respectively. In cloth, perfluorooctane sulfonamidoethanols (i.e., MeFOSE and EtFOSE) accumulated most significantly over time, reaching concentrations of up to 0.26 ng cm - 2 and 0.24 ng cm - 2 , respectively. From paired measurements of neutral PFAS in air and suspended cloth, we derived cloth-air partition coefficients ( K ca ) for 6:2, 8:2, and 10:2 FTOH; ethylperfluorooctane sulfonamide (EtFOSA); MeFOSE; and EtFOSE. Mean log( K ca ) values range from 4.7 to 6.6 and are positively correlated with the octanol-air partition coefficient. We investigated the effect of the cloth storage method on PFAS accumulation and the influence of home characteristics on air concentrations. Temperature had the overall greatest effect. This study provides valuable insights into PFAS distribution, fate, and exposure indoors.

Indoor surfaces can act as reservoirs and reaction media influencing the concentrations and type of species that people are exposed to indoors. Mass accommodation and partitioning are impacted by the phase state and viscosity of indoor surface films. We developed the kinetic multi-layer model KM-FILM to simulate organic film formation and growth, but it is computationally expensive to couple such comprehensive models with indoor air box models. Recently, a novel effective mass accommodation coefficient ( α eff ) was introduced for efficient and effective treatments of gas-particle partitioning. In this study, we extended this approach to a film geometry with α eff as a function of penetration depth into the film, partitioning coefficient, bulk diffusivity, and condensed-phase reaction rate constant. Comparisons between KM-FILM and the α eff method show excellent agreement under most conditions, but with deviations before the establishment of quasi-equilibrium within the penetration depth. We found that the deposition velocity of species and overall film growth are impacted by bulk diffusivity in highly viscous films ( D b ∼<10 -15 cm 2 s -1 ). Reactions that lead to non-volatile products can increase film thicknesses significantly, with the extent of film growth being dependent on the gas-phase concentration, rate coefficient, partitioning coefficient and diffusivity. Amorphous semisolid films with D b > ∼10 -17 -10 -19 cm 2 s -1 can be efficient SVOC reservoirs for compounds with higher partitioning coefficients as they can be released back to the gas phase over extended periods of time, while glassy solid films would not be able to act as reservoirs as gas-film partitioning is impeded.

Background: Fugacity, the driving force for transdermal uptake of chemicals, can be difficult to predict based only on the composition of complex, non-ideal mixtures such as personal care products., Objective: Compare the predicted transdermal uptake of benzophenone-3 (BP-3) from sunscreen lotions, based on direct measurements of BP-3 fugacity in those products, to results of human subject experiments., Methods: We measured fugacity relative to pure BP-3, for commercial sunscreens and laboratory mixtures, using a previously developed/solid-phase microextraction (SPME) method. The measured fugacity was combined with a transdermal uptake model to simulate urinary excretion rates of BP-3 resulting from sunscreen use. The model simulations were based on the reported conditions of four previously published human subject studies, accounting for area applied, time applied, showering and other factors., Results: The fugacities of commercial lotions containing 3-6% w/w BP-3 were ~20% of the supercooled liquid vapor pressure. Simulated dermal uptake, based on these fugacities, are within a factor of 3 of the mean results reported from two human-subject studies. However, the model significantly underpredicts total excreted mass from two other human-subject studies. This discrepancy may be due to limitations in model inputs, such as fugacity of BP-3 in lotions used in those studies., Significance: The results suggest that combining measured fugacity with such a model may provide order-of-magnitude accurate predictions of transdermal uptake of BP-3 from daily application of sunscreen products., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Reactive oxygen species (ROS) are among the species thought to be responsible for the adverse health effects of particulate matter (PM) inhalation. Field studies suggest that indoor sources of ROS contribute to measured ROS on PM in indoor air. We hypothesize that ozone reacts on indoor surfaces to form semi-volatile ROS, in particular organic peroxides (OPX), which partition to airborne particles. To test this hypothesis, we modeled ozone-induced formation of OPX, its decay and its partitioning to PM in a residential building and compared the results to field measurements. Simulations indicate that, while ROS of outdoor origin is the primary contributor to indoor ROS (in PM), a substantial fraction of ROS present in indoor PM is from ozone-surface chemistry. At an air change rate equal to 1/h, and an outdoor ozone mixing ratio of 35 ppb, 25% of the ROS concentration in air is due to indoor formation and partitioning of OPX to PM. For the same conditions, but with a modest indoor source of PM (1.5 mg h -1 ), 44% of indoor ROS on PM is of indoor origin. An indoor source of ozone, such as an electrostatic air cleaner, also increases OPX present in indoor PM. The results of the simulations support the hypothesis that ozone-induced formation of OPX on indoor surfaces, and subsequent partitioning to aerosols, is sufficient to explain field observations. Therefore, indoor sourced ROS could contribute meaningfully to total inhaled PM-ROS.

From the thermodynamic perspective, the term temperature is clearly defined for ideal physical systems: A unique temperature can be assigned to each black body via its radiation spectrum, and the temperature of an ideal gas is given by the velocity distribution of the molecules. While the indoor environment is not an ideal system, fundamental physical and chemical processes, such as diffusion, partitioning equilibria, and chemical reactions, are predictably temperature-dependent. For example, the logarithm of reaction rate and equilibria constants are proportional to the reciprocal of the absolute temperature. It is therefore possible to have non-linear, very steep changes in chemical phenomena over a relatively small temperature range. On the contrary, transport processes are more influenced by spatial temperature, momentum, and pressure gradients as well as by the density, porosity, and composition of indoor materials. Consequently, emergent phenomena, such as emission rates or dynamic air concentrations, can be the result of complex temperature-dependent relationships that require a more empirical approach. Indoor environmental conditions are further influenced by the thermal comfort needs of occupants. Not only do occupants have to create thermal conditions that serve to maintain their core body temperature, which is usually accomplished by wearing appropriate clothing, but also the surroundings must be adapted so that they feel comfortable. This includes the interaction of the living space with the ambient environment, which can vary greatly by region and season. Design of houses, apartments, commercial buildings, and schools is generally utility and comfort driven, requiring an appropriate energy balance, sometimes considering ventilation but rarely including the impact of temperature on indoor contaminant levels. In our article, we start with a review of fundamental thermodynamic variables and discuss their influence on typical indoor processes. Then, we describe the heat balance of people in their thermal environment. An extensive literature study is devoted to the thermal conditions in buildings, the temperature-dependent release of indoor pollutants from materials and their distribution in the various interior compartments as well as aspects of indoor chemistry. Finally, we assess the need to consider temperature holistically with regard to the changes to be expected as a result of global emergencies such as climate change., (© 2022 The Authors. Indoor Air published by John Wiley & Sons Ltd.)

This research investigates sorption of PCBs to fabrics in a contaminated indoor environment and the effect of laundering on PCB removal from the fabrics. Eight articles of clothing were exposed to the air in a PCB-contaminated building. The background air concentration was 670 ng/m 3 PCB total with PCB-52 being the main congener. Air and fabric samples were collected for analysis before and periodically throughout the experiment. After 25 weeks, the remaining fabrics were washed and cut into three pieces each. One part was dried in the contaminated building, second in a PCB-free building and third in a mechanical drier. The PCB mass concentration increased during the first 6-10 weeks for all investigated fabrics, after which some fabrics approached equilibrium for more volatile congeners. Mass-normalized cloth-air partition coefficients were quantified for 9 congeners; for PCB-52, these ranged from 10 6 . 1 to 10 7.0 which were consistent with previously reported values. Partition coefficients of PCBs were observed to increase with their respective octanol-air partition coefficients. Washing and drying clothes resulted in the removal between 22% and 84% of PCBs. There was no difference in removal percentage after air-drying in clean or contaminated air. Drying in a mechanical drier removed significantly more PCBs than air-drying., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Detailed offline speciation of gas- and particle-phase organic compounds was conducted using gas/liquid chromatography with traditional and high-resolution mass spectrometers in a hybrid targeted/nontargeted analysis. Observations were focused on an unoccupied home and were compared to two other indoor sites. Observed gas-phase organic compounds span the volatile to semivolatile range, while functionalized organic aerosols extend from intermediate volatility to ultra-low volatility, including a mix of oxygen, nitrogen, and sulfur-containing species. Total gas-phase abundances of hydrocarbon and oxygenated gas-phase complex mixtures were elevated indoors and strongly correlated in the unoccupied home. While gas-phase concentrations of individual compounds generally decreased slightly with greater ventilation, their elevated ratios relative to controlled emissions of tracer species suggest that the dilution of gas-phase concentrations increases off-gassing from surfaces and other indoor reservoirs, with volatility-dependent responses to dynamically changing environmental factors. Indoor-outdoor emissions of gas-phase intermediate-volatility/semivolatile organic hydrocarbons from the unoccupied home averaged 6-11 mg h -1 , doubling with ventilation. While the largest single-compound emissions observed were furfural (61-275 mg h -1 ) and acetic acid, observations spanned a wide range of individual volatile chemical products (e.g., terpenoids, glycol ethers, phthalates, other oxygenates), highlighting the abundance of long-lived reservoirs resulting from prior indoor use or materials, and their gradual transport outdoors.

Reactive oxygen species (ROS) are an important contributor to adverse health effects associated with ambient air pollution. Despite infiltration of ROS from outdoors, and possible indoor sources (eg, combustion), there are limited data available on indoor ROS. In this study, part of the second phase of Air Composition and Reactivity from Outdoor aNd Indoor Mixing campaign (ACRONIM-2), we constructed and deployed an online, continuous, system to measure extracellular gas- and particle-phase ROS during summer in an unoccupied residence in St. Louis, MO, USA. Over a period of one week, we observed that the non-denuded outdoor ROS (representing particle-phase ROS and some gas-phase ROS) concentration ranged from 1 to 4 nmol/m 3 (as H 2 O 2 ). Outdoor concentrations were highest in the afternoon, coincident with peak photochemistry periods. The indoor concentrations of particle-phase ROS were nearly equal to outdoor concentrations, regardless of window-opening status or air exchange rates. The indoor/outdoor ratio of non-denuded ROS (I/O ROS ) was significantly less than 1 with windows open and even lower with windows closed. Combined, these observations suggest that gas-phase ROS are efficiently removed by interior building surfaces and that there may be an indoor source of particle-phase ROS., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Models of transdermal uptake of chemicals from clothing have been developed, but not compared with recent human subject experiments. In a well-characterized experiment, participants wore t-shirts pre-dosed with benzophenone-3 (BP-3) and BP-3 and a metabolite were monitored in urine voids., Objective: Compare a dynamic model of transdermal uptake from clothing to results of the human subject experiment., Methods: The model simulating dynamic transdermal uptake from clothing was coupled with direct measurements of the gas phase concentration of benzophenone-3 (BP-3) near the surface of clothing to simulate the conditions of the human subject experiment., Results: The base-case model results were consistent with the those reported for human subjects. The results were moderately sensitive to parameters such as the diffusivity in the stratum corneum (SC), the SC thickness, and SC-air partition coefficient. The model predictions were most sensitive to the clothing fit. Tighter clothing worn during exposure period significantly increased excretion rates but tighter fit "clean" clothing during post-exposure period acts as a sink that reduces transdermal absorption by transferring BP-3 from skin surface lipids to clothing. The shape of the excretion curve was most sensitive to the diffusivity in the SC and clothing fit., Significance: This research provides further support for clothing as an important mediator of dermal exposure to environmental chemicals.

The skin of 20 human participants was exposed to ∼110 ppb O 3 and volatile products of the resulting chemistry were quantified in real time. Yields (ppb product emitted/ppb ozone consumed) for 40 products were quantified. Major products of the primary reaction of ozone-squalene included 6-methyl 5-hepten-2-one (6-MHO) and geranyl acetone (GA) with average yields of 0.22 and 0.16, respectively. Other major products included decanal, methacrolein (or methyl vinyl ketone), nonanal, and butanal. Yields varied widely among participants; summed yields ranged from 0.33 to 0.93. The dynamic increase in emission rates during ozone exposure also varied among participants, possibly indicative of differences in the thickness of the skin lipid layer. Factor analysis indicates that much of the variability among participants is due to factors associated with the relative abundance of (1) "fresh" skin lipid constituents (such as squalene and fatty acids), (2) oxidized skin lipids, and (3) exogenous compounds. This last factor appears to be associated with the presence of oleic and linoleic acids and could be accounted for by uptake of cooking oils or personal care products to skin lipids.

A critical review of the current state of knowledge of chemical emissions from indoor sources, partitioning among indoor compartments, and the ensuing indoor exposure leads to a proposal for a modular mechanistic framework for predicting human exposure to semivolatile organic compounds (SVOCs). Mechanistically consistent source emission categories include solid, soft, frequent contact, applied, sprayed, and high temperature sources. Environmental compartments are the gas phase, airborne particles, settled dust, indoor surfaces, and clothing. Identified research needs are the development of dynamic emission models for several of the source emission categories and of estimation strategies for critical model parameters. The modular structure of the framework facilitates subsequent inclusion of new knowledge, other chemical classes of indoor pollutants, and additional mechanistic processes relevant to human exposure indoors. The framework may serve as the foundation for developing an open-source community model to better support collaborative research and improve access for application by stakeholders. Combining exposure estimates derived using this framework with toxicity data for different end points and toxicokinetic mechanisms will accelerate chemical risk prioritization, advance effective chemical management decisions, and protect public health.

Chemical reactions on indoor surfaces play an important role in air quality in indoor environments, where humans spend 90% of their time. We focus on the challenges of understanding the complex chemistry that takes place on indoor surfaces and identify crucial steps necessary to gain a molecular-level understanding of environmental indoor surface chemistry: (1) elucidate key surface reaction mechanisms and kinetics important to indoor air chemistry, (2) define a range of relevant and representative surfaces to probe, and (3) define the drivers of surface reactivity, particularly with respect to the surface composition, light, and temperature. Within the drivers of surface composition are the roles of adsorbed/absorbed water associated with indoor surfaces and the prevalence, inhomogeneity, and properties of secondary organic films that can impact surface reactivity. By combining laboratory studies, field measurements, and modeling we can gain insights into the molecular processes necessary to further our understanding of the indoor environment., (© 2020 Elsevier Inc.)

A growing body of evidence identifies clothing as an important mediator of human exposure to chemicals and particles, which may have public health significance. This paper reviews and critically assesses the state of knowledge regarding how clothing, during wear, influences exposure to molecular chemicals, abiotic particles, and biotic particles, including microbes and allergens. The underlying processes that govern the acquisition, retention, and transmission of clothing-associated contaminants and the consequences of these for subsequent exposures are explored. Chemicals of concern have been identified in clothing, including byproducts of their manufacture and chemicals that adhere to clothing during use and care. Analogously, clothing acts as a reservoir for biotic and abiotic particles acquired from occupational and environmental sources. Evidence suggests that while clothing can be protective by acting as a physical or chemical barrier, clothing-mediated exposures can be substantial in certain circumstances and may have adverse health consequences. This complex process is influenced by the type and history of the clothing; the nature of the contaminant; and by wear, care, and storage practices. Future research efforts are warranted to better quantify, predict, and control clothing-related exposures.

Accumulation of chemicals from the environment to clothing and other textiles can influence human uptake by several exposure routes. In this research, we demonstrate that the cloth-air equilibrium distribution ratio for species i, K CA&#95;i, can be measured relatively easily and quickly using headspace analysis of cloth dosed with two common indoor air SVOCs, diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP). A known mass of a phthalate was applied to the cloth in a volatile solvent carrier. After evaporation of the solvent, the cloth was placed in a vial and allowed to equilibrate with the air in the vial. Since the volume of headspace air is small, the total mass required to transfer from cloth to air is small and also the time required for air equilibration with the fabric surface is very short (minutes). Distribution ratios for the two phthalate esters sorbed to cotton jean material, reported as the concentration in the bulk cloth divided by the air concentration, were measured at 20, 25, 32, and 40 °C. The volume-normalized distribution ratio, K vol [(μg/m 3 )/(μg/m 3 )], ranged from (0.75 ± 0.01)× 10 5 to (5.6 ± 0.2) × 10 5 for DEP and (5 ± 0.3)× 10 5 to (57 ± 1) × 10 5 for DnBP. Mass-normalized distribution ratio, K mass [m 3 /g], ranged from (0.25 ± 0.01) to (1.8 ± 0.1) for DEP and (1.6 ± 0.1) to (18.5 ± 0.5) for DnBP. The cloth-air distribution ratios obtained from this study compare favorably with previously published results using other methods. Although equilibration with air in the headspace can be rapid, diffusion into the textile fibers is a slower equilibration process. Overall, this simple method has the potential to rapidly generate distribution ratios for a large number of chemical-textile pairs., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Polychlorinated biphenyl (PCB) contamination of buildings continues to pose an exposure threat, even decades after their application in the form of calks and other building materials. In this research, we investigate the ability of clothing to sorb PCBs from contaminated air and thereby influence exposure. The equilibrium concentration of PCB-28 and PCB-52 was quantified for nine used clothing fabrics exposed for 56 days to air in a Danish apartment contaminated with PCBs. Fabric materials included pure materials such as cotton and polyester, or blends of polyester, cotton, viscose/rayon, and/or elastane. Air concentrations were fairly stable over the experimental period, with PCB-28 ranging from 350 to 430 ng/m 3 and PCB-52 ranging from 460 to 550 ng/m 3 . Mass accumulated in fabric ranged from below detection limits to 4.5 mg/g of fabric. Cotton or materials containing elastane sorbed more than polyester materials on a mass basis. Mass-normalized partition coefficients above detection limits ranged from 10 5.7 to 10 7.0  L/kg. Clothing acts as a reservoir for PCBs that extends dermal exposure, even when outside or in uncontaminated buildings., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Benzophenone-3 (also known as BP-3 or oxybenzone) is added to sunscreens, plastics, and some coatings to filter UV radiation. The suspected endocrine disruptor BP-3 has been detected in the air and settled dust of homes and is expected to redistribute from its original sources to other indoor compartments, including clothing. Given its physical and chemical properties, we hypothesized that dermal uptake from clothing could contribute to the body burden of this compound. First, cotton shirts were exposed to air at an elevated concentration of BP-3 for 32 days; the final air concentration was 4.4 μg/m 3 . Next, three participants wore the exposed shirts for 3 h. After 3 h of exposure, participants wore their usual clothing during the collection of urine samples for the next 48 h. Urine was analyzed for BP-3, a metabolite (BP-1), and six other UV filters. The rate of urinary excretion of the sum of BP-1 and BP-3 increased for all participants during and following the 3 h of exposure. The summed mass of BP-1 and BP-3 excreted during the first 24 h attributable to wearing exposed t-shirts were 12, 9.9, and 82 μg for participants 1, 2, and 3, respectively. Analysis of these results, coupled with predictions of steady-state models, suggest that dermal uptake of BP-3 from clothing could meaningfully contribute to overall body burden.

An INdoor air Detailed Chemical Model was developed to investigate the impact of ozone reactions with indoor surfaces (including occupants), on indoor air chemistry in simulated apartments subject to ambient air pollution. The results are consistent with experimental studies showing that approximately 80% of ozone indoors is lost through deposition to surfaces. The human body removes ozone most effectively from indoor air per square meter of surface, but the most significant surfaces for C 6 -C 10 aldehyde formation are soft furniture and painted walls owing to their large internal surfaces. Mixing ratios of between 8 and 11 ppb of C 6 -C 10 aldehydes are predicted to form in apartments in various locations in summer, the highest values are when ozone concentrations are enhanced outdoors. The most important aldehyde formed indoors is predicted to be nonanal (5-7 ppb), driven by oxidation-derived emissions from painted walls. In addition, ozone-derived emissions from human skin were estimated for a small bedroom at nighttime with concentrations of nonanal, decanal, and 4-oxopentanal predicted to be 0.5, 0.7, and 0.7 ppb, respectively. A detailed chemical analysis shows that ozone-derived surface aldehyde emissions from materials and people change chemical processing indoors, through enhanced formation of nitrated organic compounds and decreased levels of oxidants., (© 2017 The Authors. Indoor Air Published by John Wiley & Sons Ltd.)

In this research, we extend a model of transdermal uptake of phthalates to include a layer of clothing. When compared with experimental results, this model better estimates dermal uptake of diethylphthalate and di-n-butylphthalate (DnBP) than a previous model. The model predictions are consistent with the observation that previously exposed clothing can increase dermal uptake over that observed in bare-skin participants for the same exposure air concentrations. The model predicts that dermal uptake from clothing of DnBP is a substantial fraction of total uptake from all sources of exposure. For compounds that have high dermal permeability coefficients, dermal uptake is increased for (i) thinner clothing, (ii) a narrower gap between clothing and skin, and (iii) longer time intervals between laundering and wearing. Enhanced dermal uptake is most pronounced for compounds with clothing-air partition coefficients between 10 4 and 10 7 . In the absence of direct measurements of cotton cloth-air partition coefficients, dermal exposure may be predicted using equilibrium data for compounds in equilibrium with cellulose and water, in combination with computational methods of predicting partition coefficients., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To identify baseline sound levels, patterns of sound levels, and potential barriers and facilitators to sound level reduction. The study setting was neonatal and pediatric intensive care units in a tertiary care hospital. Participants were staff in both units and parents of currently hospitalized children or infants. One 24-hour sound measurements and one 4-hour sound measurement linked to observed sound events were conducted in each area of the center's neonatal intensive care unit. Two of each measurement type were conducted in the pediatric intensive care unit. Focus groups were conducted with parents and staff. Transcripts were analyzed with descriptive content analysis and themes were compared against results from quantitative measurements. Sound levels exceeded recommended standards at nearly every time point. The most common code was related to talking. Themes from focus groups included the critical care context and sound levels, effects of sound levels, and reducing sound levels-the way forward. Results are consistent with work conducted in other critical care environments. Staff and families realize that high sound levels can be a problem, but feel that the culture and context are not supportive of a quiet care space. High levels of ambient sound suggest that the largest changes in sound levels are likely to come from design and equipment purchase decisions. L10 and Lmax appear to be the best outcomes for measurement of behavioral interventions.

To better understand the dermal exposure pathway, we enhance an existing mechanistic model of transdermal uptake by including skin surface lipids (SSL) and consider the impact of clothing. Addition of SSL increases the overall resistance to uptake of SVOCs from air but also allows for rapid transfer of SVOCs to sinks like clothing or clean air. We test the model by simulating di-ethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) exposures of six bare-skinned (Weschler et al. 2015, Environ. Health Perspect., 123, 928) and one clothed participant (Morrison et al. 2016, J. Expo. Sci. Environ. Epidemiol., 26, 113). The model predicts total uptake values that are consistent with the measured values. For bare-skinned participants, the model predicts a normalized mass uptake of DEP of 3.1 (μg/m 2 )/(μg/m 3 ), whereas the experimental results range from 1.0 to 4.3 (μg/m 2 )/(μg/m 3 ); uptake of DnBP is somewhat overpredicted: 4.6 (μg/m 2 )/(μg/m 3 ) vs. the experimental range of 0.5-3.2 (μg/m 2 )/(μg/m 3 ). For the clothed participant, the model predicts higher than observed uptake for both species. Uncertainty in model inputs, including convective mass transfer coefficients, partition coefficients, and diffusion coefficients, could account for overpredictions. Simulations that include transfer of skin oil to clothing improve model predictions. A dynamic model that includes SSL is more sensitive to changes that impact external mass transfer such as putting on and removing clothes and bathing., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To assess the influence of clothing on dermal uptake of semi-volatile organic compounds (SVOCs), we measured uptake of selected airborne phthalates for an individual wearing clean clothes or air-exposed clothes and compared these results with dermal uptake for bare-skinned individuals under otherwise identical experimental conditions. Using a breathing hood to isolate dermal from inhalation uptake, we measured urinary metabolites of diethylphthalate (DEP) and di-n-butylphthalate (DnBP) from an individual exposed to known concentrations of these compounds for 6 h in an experimental chamber. The individual wore either clean (fresh) cotton clothes or cotton clothes that had been exposed to the same chamber air concentrations for 9 days. For a 6-h exposure, the net amounts of DEP and DnBP absorbed when wearing fresh clothes were, respectively, 0.017 and 0.007 μg/kg/(μg/m(3)); for exposed clothes the results were 0.178 and 0.261 μg/kg/(μg/m(3)), respectively (values normalized by air concentration and body mass). When compared against the average results for bare-skinned participants, clean clothes were protective, whereas exposed clothes increased dermal uptake for DEP and DnBP by factors of 3.3 and 6.5, respectively. Even for non-occupational environments, wearing clothing that has adsorbed/absorbed indoor air pollutants can increase dermal uptake of SVOCs by substantial amounts relative to bare skin.

Contaminant concentrations in trees have been used to delineate groundwater contaminant plumes (i.e., phytoscreening); however, variability in tree composition hinders accurate measurement of contaminant concentrations in planta, particularly for long-term monitoring. This study investigated in planta passive sampling devices (PSDs), termed solid phase samplers (SPSs) to be used as a surrogate tree core. Characteristics studied for five materials included material-air partitioning coefficients (Kma) for chlorinated solvents, sampler equilibration time and field suitability. The materials investigated were polydimethylsiloxane (PDMS), low-density polyethylene (LDPE), linear low-density polyethylene (LLDPE), polyoxymethylene (POM) and plasticized polyvinyl chloride (PVC). Both PDMS and LLDPE samplers demonstrated high partitioning coefficients and diffusivities and were further tested in greenhouse experiments and field trials. While most of the materials could be used for passive sampling, the PDMS SPSs performed best as an in planta sampler. Such a sampler was able to accurately measure trichloroethylene (TCE) and tetrachloroethylene (PCE) concentrations while simultaneously incorporating simple operation and minimal impact to the surrounding property and environment., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: To assess potential hypercoagulability during diabetic ketoacidosis in children., Design: A prospective, controlled pilot study., Setting: University-affiliated pediatric critical care unit and emergency department in a tertiary care children's hospital., Patients: Children (1-18 years) admitted with an episode of diabetic ketoacidosis and healthy children as controls. All patients with diabetic ketoacidosis managed according to a preestablished protocol., Interventions: Thromboelastography was performed using citrated whole-blood samples drawn at the time of admission and upon biochemical and clinical resolution of diabetic ketoacidosis. Citrated whole-blood samples drawn from healthy nondiabetic children acted as control samples., Measurements and Main Results: Fifteen patients (11.7 ± 4.1 years) in the diabetic ketoacidosis group and 20 patients (8.9 ± 4.5 years; p = 0.06) in the control group completed the study. Values for standard thromboelastography parameters (R and K time, α angle, maximum amplitude, coagulation index, and Ly30) in the diabetic ketoacidosis group, both on admission and resolution, were within the control range; thromboelastography profiles of diabetic ketoacidosis patients on admission were not significantly different from profiles obtained upon diabetic ketoacidosis resolution. The mean α-angle was significantly higher in known diabetic patients compared with newly diagnosed diabetics on admission; however, it still remained within the control normal range., Conclusions: Thromboelastographic assay results do not reflect a hypercoagulable state in this group of children with diabetic ketoacidosis. Further investigation is required to examine the potential role of injured endothelium in the suspected hypercoagulability during diabetic ketoacidosis.

Acquired hypernatremia in hospitalized patients is often associated with poorer outcomes. Our aim was to evaluate the relationship between acquired hypernatremia and outcome in children with severe traumatic brain injury (sTBI). We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥12) with sTBI (Glasgow Coma Scale [GCS] ≤8 and Maximum Abbreviated Injury Scale [MAIS] ≥4) admitted to a Pediatric Critical Care Unit ([PCCU]; 2000-2009). In a cohort of 165 patients, 76% had normonatremia (135-150 mmol/L), 18% had hypernatremia (151-160 mmol/L), and 6% had severe hypernatremia (>160 mmol/L). The groups were similar except for lower GCS (p=0.002) and increased incidence of fixed pupil(s) on admission in both hypernatremia groups (p<0.001). Mortality rate was four-fold and six-fold greater with hypernatremia and severe hypernatremia, respectively (p<0.001), and mortality rates were unchanged when patients with fixed pupils or those with central diabetes insipidus were excluded (p<0.001). Hypernatremic patients had fewer ventilator-free days (p<0.001). Survivors with hypernatremia had greater PCCU (p=0.001) and hospital (p=0.031) lengths of stays and were less frequently discharged home (p=0.008). Logistic regression analyses of patient characteristics and sTBI interventions demonstrated that hypernatremia was independently associated with the presence of fixed pupil(s) on admission (odds ratio [OR] 5.38; p=0.003); administration of thiopental (OR 8.64; p=0.014), and development of central diabetes insipidus (OR 5.66; p=0.005). Additional logistic regression analyses demonstrated a significant association between hypernatremia and mortality (OR 6.660; p=0.034). In summary, acquired hypernatremia appears to signal higher risk of mortality in pediatric sTBI and is associated with a higher discharge level of care in sTBI survivors.

Objectives: To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality., Design: Retrospective chart and imaging review., Setting: Children's Hospital, level 1 trauma center., Patients: Severely injured (Injury Severity Score ≥ 12) pediatric trauma patients (>1 month and <18 yr) with severe traumatic brain injury (presedation Glasgow Coma Scale ≤ 8 and head Maximum Abbreviated Injury Scale ≥ 4) that developed acute central diabetes insipidus between January 2000 and December 2011., Measurements and Main Results: Of 818 severely injured trauma patients, 180 had severe traumatic brain injury with an overall mortality rate of 27.2%. Thirty-two of the severe traumatic brain injury patients developed acute central diabetes insipidus that responded to desamino-8-D-arginine vasopressin and/or vasopressin infusion, providing an occurrence rate of 18%. At the time of central diabetes insipidus diagnosis, median urine output and serum sodium were 6.8 ml/kg/hr (interquartile range = 5-11) and 154 mmol/L (interquartile range = 149-159), respectively. The mortality rate of central diabetes insipidus patients was 87.5%, with 71.4% declared brain dead after central diabetes insipidus diagnosis. Early central diabetes insipidus onset, within the first 2 days of severe traumatic brain injury, was strongly associated with mortality (p < 0.001), as were a lower presedation Glasgow Coma Scale (p = 0.03), a lower motor Glasgow Coma Scale (p = 0.01), an occurrence of fixed pupils (p = 0.04), and a prolonged partial thromboplastin time (p = 0.04). Cerebral edema on the initial computed tomography, obtained in the first 24 hrs after injury, was the only imaging finding associated with death (p = 0.002). Survivors of central diabetes insipidus were more likely to have intracranial pressure monitoring (p = 0.03), have thiopental administered to induce coma (p = 0.04) and have received a decompressive craniectomy for elevated intracranial pressure (p = 0.04)., Conclusions: The incidence of central diabetes insipidus in pediatric patients with severe traumatic brain injury is 18%. Mortality was associated with early central diabetes insipidus onset and cerebral edema on head computed tomography. Central diabetes insipidus nonsurvivors were less likely to have received intracranial pressure monitoring, thiopental coma and decompressive craniectomy.

Objectives: Despite widespread use of dental benefit limits in terms of the types of services provided, an annual maximum on claims, or both, there is a dearth of literature examining their impact on either cost to the insurer or health outcomes. This study uses a natural experiment to examine dental care utilization and expenditure changes following Indiana Medicaid's introduction of a $600 individual annual limit on adult dental expenditure in 2003., Methods: In a before and after comparison, we use two separate cross-sections of paid claims for 96+ percent of the Medicaid adult population. Paid claims were available as a per-member-per-year (PMPY) figure., Results: Between 2002 and 2007, the eligible population decreased 3 percent (from 323,209 to 313,623), yet the number of people receiving any dental services increased 60 percent and total Medicaid dental claims increased 18 percent (from $34.1 million to $40.1 million). In both years, those Dually (Medicare/Medicaid) Eligible had the largest percentage of members receiving services, about 75 percent, and the Disabled Adult group had the lowest percentage (5-8 percent), yet both populations are likely to have high dental need due to effects of chronic conditions and medications., Conclusions: The increase in the number and percentage of people receiving Diagnostic and Restorative care suggests that the expenditure limit's introduction did not impose a barrier to accessing basic dental services. However, among those receiving any service, PMPY claims fell by 37 percent and 31 percent among the Dually Eligible and Disabled Adults categories, respectively, suggesting that the benefit limit affected these generally high need populations most., (© 2012 American Association of Public Health Dentistry.)

The health effects associated with exposure to ozone range from respiratory irritation to increased mortality. In this paper, we explore the use of three green building materials and an activated carbon (AC) mat that remove ozone from indoor air. We studied the effects of long-term exposure of these materials to real environments on ozone removal capability and pre- and post-ozonation emissions. A field study was completed over a 6-month period, and laboratory testing was intermittently conducted on material samples retrieved from the field. The results show sustained ozone removal for all materials except recycled carpet, with greatest ozone deposition velocity for AC mat (2.5-3.8 m/h) and perlite-based ceiling tile (2.2-3.2 m/h). Carbonyl emission rates were low for AC across all field sites. Painted gypsum wallboard and perlite-based ceiling tile had similar overall emission rates over the 6-month period, while carpet had large initial emission rates of undesirable by-products that decayed rapidly but remained high compared with other materials. This study confirms that AC mats and perlite-based ceiling tile are viable surfaces for inclusion in buildings to remove ozone without generating undesirable by-products. PRACTICAL IMPLICATIONS The use of passive removal materials for ozone control could decrease the need for, or even render unnecessary, active but energy consuming control solutions. In buildings where ozone should be controlled (high outdoor ozone concentrations, sensitive populations), materials specifically designed or selected for removing ozone could be implemented, as long as ozone removal is not associated with large emissions of harmful by-products. We find that activated carbon mats and perlite-based ceiling tiles can provide substantial, long-lasting, ozone control., (© 2011 John Wiley & Sons A/S.)

Unlabelled: Reaction rates and reaction probabilities have been quantified on model indoor surfaces for the reaction of ozone with two monoterpenes (Δ(3) -carene and d-limonene). Molar surface loadings were obtained by performing breakthrough experiments in a plug-flow reactor (PFR) packed with beads of glass, polyvinylchloride or zirconium silicate. Reaction rates and probabilities were determined by equilibrating the PFR with both the terpene and the ozone and measuring the ozone consumption rate. To mimic typical indoor conditions, temperatures of 20, 25, and 30°C were used in both types of experiments along with a relative humidity ranging from 10% to 80%. The molar surface loading decreased with increased relative humidity, especially on glass, suggesting that water competed with the terpenes for adsorption sites. The ozone reactivity experiments indicate that higher surface loadings correspond with higher ozone uptake. The reaction probability for Δ(3) -carene with ozone ranged from 2.9 × 10(-6) to 3.0 × 10(-5) while reaction probabilities for d-limonene ranged from 2.8 × 10(-5) to 3.0 × 10(-4) . These surface reaction probabilities are roughly 10-100 times greater than the corresponding gas-phase values. Extrapolation of these results to typical indoor conditions suggests that surface conversion rates may be substantial relative to gas-phase rates, especially for lower volatility terpenoids., Practical Implications: At present, it is unclear how important heterogeneous reactions will be in influencing indoor concentrations of terpenes, ozone and their reaction products. We observe that surface reaction probabilities were 10 to 100 times greater than their corresponding gas-phase values. Thus indoor surfaces do enhance effective reaction rates and adsorption of terpenes will increase ozone flux to otherwise low-reactivity surfaces. Extrapolation of these results to typical indoor conditions suggests that surface conversion rates may be substantial relative to gas-phase rates, especially for lower volatility terpenoids., (© 2011 John Wiley & Sons A/S.)

Ozone can react homogeneously with unsaturated organic compounds in buildings to generate undesirable products. However, these reactions can also occur on indoor surfaces, especially for low-volatility organics. Conversion rates of ozone with α-terpineol, a representative low-volatility compound, were quantified on surfaces that mimic indoor substrates. Rates were measured for α-terpineol adsorbed to beads of glass, polyvinylchloride (PVC), and dry latex paint, in a plug flow reactor. A newly defined second-order surface reaction rate coefficient, k(2), was derived from the flow reactor model. The value of k(2) ranged from 0.68 × 10(-14) cm(4)s(-1)molecule(-1) for α-terpineol adsorbed to PVC to 3.17 × 10(-14) cm(4)s(-1)molecule(-1) for glass, but was insensitive to relative humidity. Further, k(2) is only weakly influenced by the adsorbed mass but instead appears to be more strongly related to the interfacial activity α-terpineol. The minimum reaction probability ranged from 3.79 × 10(-6) for glass at 20% RH to 6.75 × 10(-5) for PVC at 50% RH. The combination of high equilibrium surface coverage and high reactivity for α-terpineol suggests that surface conversion rates are fast enough to compete with or even overwhelm other removal mechanisms in buildings such as gas-phase conversion and air exchange.

Background: Mechanical ventilation (MV) strategies are continuously evolving in an effort to minimize adverse events. The objective of this study was to determine the complications associated with MV in children., Study Design: Prospective observational study. Over a period of 10 consecutive months, 150 patients (median age 0.8 years, IQR 4.4, 59% male) were enrolled in this study., Results: The median duration of MV was 3.1 days (IQR 3.9). A total of 85 complications were observed in 60 (40%) patients (114 complications per 1,000 ventilation days). 16.7% of patients developed atelectasis, 13.3% post-extubation stridor, 9.3% failed extubation, 2.0% pneumothorax, 3.3% accidental extubation, 2.7% nasal or perioral tissue damage and 1.9% ventilator associated pneumonia. Atelectasis occurred most often in the left lower lobe (36%) or in the right upper lobe (26%). The incidence of atelectasis in children <1 year of age was 12% (31 episodes per 1,000 days of ventilation) compared to 18% (57 episodes per 1,000 days of ventilation) in children ≥ 1 year of age (P < 0.05). Patients that failed extubation were ventilated for a median of 8.5 (IQR 8.8) days compared to 2.9 days (IQR, 3.8) in patients that were successfully extubated (P < 0.01). The absence of an air leak prior to extubation did not correlate with failed extubation. Accidental extubation was limited to orally intubated patients., Conclusion: MV complications occurred in 40% of patients and most often consisted of atelectasis and post-extubation stridor. Further studies are needed to examine associated risk factors and strategies to reduce their occurrence., (Copyright © 2010 Wiley-Liss, Inc.)

Background: The purpose of this study was to evaluate the reliability, validity, and responsiveness to change of the Health Utilities Index Mark-3 (HUI-3) in heart failure (HF) for use in cost-effectiveness studies., Methods and Results: Two hundred eleven patients with HF recruited from outpatient clinics were enrolled; 165 completed the 26-week study. Patients completed 4 health-related quality of life questionnaires (baseline and 4, 8, and 26 weeks), including the HUI-3, the Medical Outcomes Study Short-form 12 (SF-12), the Minnesota Living with Heart Failure Questionnaire (LHFQ), and the Chronic Heart Failure Questionnaire (CHQ). The HUI-3 indicated moderate or fair health-related quality of life overall; the attributes most impaired were pain, ambulation, cognition, and emotion. Internal consistency reliability (Cronbach's alpha = 0.51) was low and test-retest reliability (intraclass correlation coefficient = 0.68) was adequate. The HUI-3 total score was significantly associated with the SF-12, LHFQ, and CHQ total scores. It discriminated among patients with varying New York Heart Association class (P < .001) and varying perceived health (P < .001). The HUI-3 was less responsive to perceived change in health condition than the LHFQ or the CHQ., Conclusions: The HUI-3 demonstrated satisfactory reliability and validity in this sample supporting its use in cost-effectiveness studies., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To determine the current practice and opinions of paediatric intensivists in Canada regarding tracheostomy in children with potentially reversible conditions which are anticipated to require prolonged mechanical ventilation., Design and Setting: Self-administered survey among paediatric intensivists within paediatrics critical care units (PCCU) across Canada., Measurements and Results: All 16 PCCUs participated in the survey with a response rate of 81% (63 physicians). In 14 of 16 centres one to five tracheostomies were performed during 2006. Two centres did not perform any tracheostomies. The overall rate of tracheostomy is less than 1.5%. Percutaneous technique is used in 3/16 (19%) of centres. Readiness to undertake tracheostomy during the first 21[Symbol: see text]days of illness is influenced by patient diagnosis; severe traumatic brain injury 66% vs. 42% in a 2-year-old with Guillain-Barré syndrome, 48% in a 9-year-old with Guillain-Barré syndrome, and 12% in a child with isolated ARDS. In a child with ARDS 25% of respondents would never consider tracheostomy. Age does not affect timing nor keenness for tracheostomy. The majority, 81%, believe that the risks associated with the procedure do not outweigh the potential benefits. Finally, 51% believe that tracheostomy is underutilized in children., Conclusions: Elective tracheostomy is rarely performed among ventilated children in Canada. However, 51% of physicians believe it is underutilized. The role of elective tracheostomy and the percutaneous technique in children requires further investigation.

Sorptive interactions with indoor surfaces strongly influence indoor exposure to organic pollutants. Adsorption itself may be influenced by indoor levels of common indoor gases such as CO2, NH3, and H2O. We quantified sorption characteristics of trimethylamine (TMA) on carpet and painted wallboard, while challenging the surface with gas-phase CO2, NH3 and H2O. We show that the capacity of the carpet to sorb TMA, doubles when the CO2 mixing ratio is increased from 0 to 1000 ppm CO2 at 90% relative humidity. In contrast, NH3 decreases the surface capacity of both carpet and latex paint. Sorption of TMA to these indoor materials is primarily caused by interactions at one or more interfaces. Dissolution of TMA and aqueous acid-base chemistry appear to also contribute to the overall sorptive capacity of carpet at high relative humidity. The reduction in the distribution coefficient, k(e), in the presence of NH3 is explained by competition between TMA and NH3 molecules for sites on the substrates at low-to-medium relative humidity conditions.

Field experiments were conducted in four homes during summerto quantify ozone-induced secondary emission rates (SERs) of aldehydes on indoor surfaces. Four surfaces in each house were examined: living room carpet, living room wall, kitchen floor, and kitchen counter. Upon exposure to ozone for 3 h, formaldehyde and C3-C10 saturated aldehydes, especially nonanal, were emitted as products of ozone-surface reactions. Carpet in newer homes had higher SERs than carpet in older homes. For example, the nonanal SER from the living room carpet was 80 microg m(-2) h(-1) in a 1 year old home, but only 8-20 microg m(-2) h(-1) in two homes that were greater than 10 years old. All kitchen countertops were very reactive and high SERs were observed, especially for nonanal. Product yields from countertops were consistent with the products of ozone reactions with oleic and linoleic esters, common in cooking oils. These findings suggest that carpet surfaces become depleted of reactants as they become oxidized over time. However, countertop surfaces, which are cleaned frequently or become covered in cooking oils, are continuously replenished with reactants. Over time, countertops may become the dominant contributor to indoor concentrations of secondary aldehydes. However, when total surface area is taken into account for the homes assessed, carpet is predicted to be the primary source of secondary emissions, even for older homes.

Unlabelled: Indoor surfaces have a sorptive capacity for organic pollutants which may be significantly influenced by other gases and the pH of the surface. In this research, we examine the influence of a common indoor gaseous acid, CO2, and base, NH3, on the adsorption of a volatile organic base, trimethylamine (TMA), to a mineral surface, zirconium silicate beads. Varying ammonia and CO2 within concentration ranges of indoor relevance substantially influences the sorptive capacity of this mineral surface. Increasing the CO2 mixing ratio to 1000 p.p.m. enhances surface capacity of TMA by 40-50%; increasing the NH3 mixing ratio to 10 p.p.m. decreases the TMA surface capacity by approximately 5-80% depending on relative humidity. The phenomena of dissolution of TMA into bulk surface water and acid-base chemistry in the surface water do not adequately describe equilibrium adsorption on this surface. Instead, adsorption to the dry solid or to adsorbed water layers appears to dominate. Reduction in the equilibrium partition coefficient, ke, in the presence of NH3 is due to a competition between TMA and ammonia molecules for adsorption sites. Site competition appears to follow the Langmuir competitive model and most ke values range from 0.003-0.045 m., Practical Implications: Sorptive interactions with indoor surfaces strongly influence indoor exposure to pollutants. For basic or acidic compounds, these interactions are themselves influenced by surface pH and competition with other acidic or basic gases such as CO2 and NH3. We show that CO2 tends to cause mineral surfaces to store more amines but NH3 tends to decrease this surface capacity. Given the typical range of indoor CO2 and NH3 concentrations, the indoor sorbtive capacity of amines on mineral surfaces may vary by greater than an order of magnitude.