Professor Lidia Morawska

The number of respiratory particles emitted during different respiratory activities is one of the main parameters affecting the airborne transmission of respiratory pathogens. Information on respiratory particle emission rates is mostly available for adults (few studies have investigated adolescents and children) and generally involves a limited number of subjects. In the present paper we attempted to reduce this knowledge gap by conducting an extensive experimental campaign to measure the emission of respiratory particles of more than 400 children aged 6 to 12 years while they pronounced a phonetically balanced word list at two different voice intensity levels (“speaking” and “loudly speaking”). Respiratory particle concentrations, particle distributions, and exhaled air flow rates were measured to estimate the respiratory particle emission rate. Sound pressure levels were also simultaneously measured. We found out that median respiratory particle emission rates for speaking and loudly speaking were 26 particles s −1 (range 7.1–93 particles s −1 ) and 41 particles s −1 (range 10–146 particles s −1 ), respectively. Children sex was significant for emission rates, with higher emission rates for males during both speaking and loudly speaking. No effect of age on the emission rates was identified. Concerning particle size distributions, for both respiratory activities, a main mode at approximately 0.6 µm and a second minor mode at 

Wildfires are thought to be increasing in severity and frequency as a result of climate change 1 – 5 . Air pollution from landscape fires can negatively affect human health 4 – 6 , but human exposure to landscape fire-sourced (LFS) air pollution has not been well characterized at the global scale 7 – 23 . Here, we estimate global daily LFS outdoor fine particulate matter (PM 2.5 ) and surface ozone concentrations at 0.25° × 0.25° resolution during the period 2000–2019 with the help of machine learning and chemical transport models. We found that overall population-weighted average LFS PM 2.5 and ozone concentrations were 2.5 µg m −3 (6.1% of all-source PM 2.5 ) and 3.2 µg m −3 (3.6% of all-source ozone), respectively, in 2010–2019, with a slight increase for PM 2.5 , but not for ozone, compared with 2000–2009. Central Africa, Southeast Asia, South America and Siberia experienced the highest LFS PM 2.5 and ozone concentrations. The concentrations of LFS PM 2.5 and ozone were about four times higher in low-income countries than in high-income countries. During the period 2010–2019, 2.18 billion people were exposed to at least 1 day of substantial LFS air pollution per year, with each person in the world having, on average, 9.9 days of exposure per year. These two metrics increased by 6.8% and 2.1%, respectively, compared with 2000–2009. Overall, we find that the global population is increasingly exposed to LFS air pollution, with socioeconomic disparities. The global population is increasingly exposed to daily landscape fire-sourced air pollution but there are socioeconomic disparities, with this pollution four times higher in low-income countries than in high-income countries during the period 2000–2019.

Global climate change will go along with changes in climatic conditions such as temperature, water balance and direct sunshine. As this will lead to a worsening of air quality, we have to look intensively at the matter of how we can create healthy living environments in areas with extreme air conditions. In order to serve primarily the efficient use of energy and the optimization of ventilation technology connected with new ways of constructing buildings (low energy and passive houses), “smart home technology” was introduced also in private homes. Facing demographic change, higher demands on a comfortable life and advancing mechanization of everyday life, sensor technology is increasingly implemented in order to create acceptable and improved living conditions. Thus, the term “smart home” is also linked today with the networking of home automation systems, home appliances and communications and entertainment electronics. In general, low-energy houses, which as a rule have a system of artificial ventilation, require special technologies to achieve good indoor air quality. Using modern sensor technology, it is possible to monitor not only the climatic parameters, but also the concentrations of air polluting substances, such e.g. carbon dioxide, sum parameters of volatile organic compounds (VOCs) and particles and record them in Home Energy Management Systems (HEMS). Indoor air quality and air hygiene are taken now as important aspects of smart home technology. Nevertheless, living in a smart home often puts demands on the occupants who are required to change some of their living habits. Due to the significant impact of smart home technology on everyday life in the near future, the authors have summarized the actual state-of-the-art of housing technology on indoor air quality, individual thermal comfort and living behaviour for the temperate climate zone. The main findings will be presented at the conference.

This chapter reviews and discusses the World Health Organization (WHO) guidelines related to indoor air quality (IAQ). The WHO IAQ health guidelines are developed and published after systematic reviews of evidence from medical and public health studies, and through extensive panel discussion and expert consultation, which provide an important basis for countries to develop your national indoor air standards. First, a general background is provided for establishing health-based air quality guidelines, followed by a summary of the criteria for the inclusion and exclusion of specific pollutants in these documents and a summary of the values of the numerical guidelines for IAQ. The following is a summary of existing or planned national standards or guidelines for IAQ management, including monitoring, in countries around the world, and discussed in the context of the WHO IAQ guidelines. Globally, only several countries have enacted national indoor air quality standards or health guidelines. The importance of developing a national standard or guideline for indoor air quality based on health evidence is discussed as a measure to reduce indoor exposure.

A guide for home occupants, owners, builders and local councils to reduce exposure to cooking emissions in low-middle income homes.

Motor vehicle emissions are the primary air pollution source in cities worldwide. Changes in traffic flow in a city can drastically change overall levels of air pollution. The level of air pollution may vary significantly in some street segments compared to others, and a small number of stationary ambient air pollution monitors may not capture this variation. This study aimed to evaluate air pollution before and during a new traffic plan established in March 2019 in the city of Kandy, Sri Lanka, using smart sensor technology. Street level air pollution data (PM2.5 and NO2 ) was acquired using a mobile air quality sensor unit before and during the implementation of the new traffic plan. The sensor unit was mounted on a police traffic motorcycle that travelled through the city four times per day. Air pollution in selected road segments was compared before and during the new traffic plan, and the trends at different times of the day were compared using data from a stationary smart sensor. Both PM2.5 and NO2 levels were well above the World Health Organization (WHO) 24-hour guidelines during the monitoring period, regardless of the traffic plan period. Most of the road segments had comparatively higher air pollution levels during compared to before the new traffic plan. For any given time (morning, midday, afternoon, evening), day of the week, and period (before or during the new traffic plan), the highest PM2.5 and NO2 concentrations were observed at the road segment from Girls High School to Kandy Railway Station. The mobile air pollution monitoring data provided evidence that the mean concentration of PM2.5 during the new traffic plan (116.7 µg m-3) was significantly higher than before the new traffic plan (92.3 µg m-3) (p < 0.007). Increasing spatial coverage can provide much better information on human exposure to air pollutants, which is essential to control traffic related air pollution. Before implementing a new traffic plan, careful planning and improvement of road network infrastructure could reduce air pollution in urban areas.

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.

Evidence on the associations between long-term exposure to multiple air pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher pollutant levels. We aimed to characterise the individual and joint (multi-pollutant) associations of long-term exposure to air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contributes to the mortality risk. We followed 37,442 participants with a mean age of 43.5 years in four cities in northern China (Tianjin, Shenyang, Taiyuan, and Rizhao) from January 1998 to December 2019. Annual particulate matter (PM) with diameters ≤2.5 μm (PM2.5), ≤10 μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were estimated using daily average values from satellite-derived machine learning models and monitoring stations. Time-varying Cox proportional hazards model was used to evaluate the individual association between air pollutants and mortality from non-accidental causes, cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer, accounting for demographic and socioeconomic factors. Effect modifications by age, sex, income and education level were also examined. Quantile-based g-Computation integrated with time-to-event data was additionally applied to evaluate the co-effects and the relative weight of contributions for air pollutants. During 785,807 person-years of follow-up, 5812 (15.5%) died from non-accidental causes, among which 2932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552 (1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5 μg/m3), PM2.5 (mean [baseline]: 70.2 μg/m3), SO2 (mean [baseline]: 113.0 μg/m3) and NO2 (mean [baseline]: 39.2 μg/m3) were adversely and consistently associated with all mortality outcomes. A 10 μg/m3 increase in PM2.5 was associated with higher mortality from non-accidental causes (hazard ratio 1.20; 95% confidence interval 1.17–1.23), CVDs (1.23; 1.19–1.28), non-malignant RDs (1.37; 1.25–1.49) and lung cancer (1.14; 1.05–1.23). A monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold was observed for the exposure-response relationship of mortality with individual or joint exposure to air pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant mixture, followed by SO2 or PM10. There was a strong and positive association of long-term individual and joint exposure to PM10, PM2.5, SO2, and NO2 with mortalities from non-accidental causes, CVDs, non-malignant RDs and lung cancer in high-exposure settings, with PM2.5 potentially being the main contributor. The shapes of associations were consistent with a linear or supra-linear exposure-response relationship, with no lower threshold observed within the range of concentrations in this study. National Key Research and Development Program of China, the China Scholarship Council, the National Natural Science Foundation of China, Natural Science Foundation of Guangdong Province.

This study investigated the suitability of outdoor particulate matter data obtained from a fixed monitoring station in estimating the personal deposited dose. Outdoor data were retrieved from a station located within the urban area of Lisbon and simulations were performed involving school children. Two scenarios were applied: one where only outdoor data were used assuming an outdoor exposure scenario, and a second one where an actual exposure scenario was adopted using the actual microenvironment during typical school days. Personal PM and PM dose (actual exposure scenario) was 23.4% and 20.2% higher than the ambient (outdoor exposure scenario) PM and PM doses, respectively. The incorporation of the hygroscopic growth in the calculations increased the ambient dose of PM and PM by 8.8% and 21.7%, respectively. Regression analysis between the ambient and personal dose showed no linearity with R at 0.07 for PM and 0.22 for PM . On the other hand, linear regression between the ambient and school indoor dose showed no linearity (R = 0.01) for PM but moderate (R = 0.48) for PM . These results demonstrate that ambient data must be used with caution for the representativeness of a realistic personal dose of PM while for PM the ambient data cannot be used as a surrogate of a realistic personal dose of school children.

Pollutants in the indoor environment are a complex mixture of gases, vapours and particles in either liquid or solid phase, suspended in the air, settled or adsorbed on or attached to indoor surfaces. The pollutants originate from a multiplicity of indoor and outdoor sources. The pollutant mixture is dynamic, involved in numerous physical and chemical processes and changing its characteristics with time. Its composition and concentration depend on the strengths of indoor sources, pollutants’ concentration outside and the properties of heating ventilation and air conditioning systems. The spatial distribution of pollutant concentration within the indoor environment is often inhomogeneous. Particulate matter in the indoor environment includes particles, which are airborne as well as those which are settled on indoor surfaces, dust. The particles vary in chemical properties, which depend on the origin of the particles and differ for particles in different size ranges. The particles can, for example, be combustion or nucleation products, dust or bioaerosols and can act as carriers of adsorbed chemicals, bio-contaminants or condensed gases. Particles are a key component of emissions from all the combustion sources. In particular, a significant indoor combustion product, environmental tobacco smoke (ETS) is a mixture of particle and gaseous products of smoke exhaled to the air by smokers and mixed with the smoke resulting from smouldering of a cigarette between the puffs. This chapter is focused on particulate matter, its origin, characteristics and behaviour in the indoor environment. In addition, several important classes of indoor pollutants are discussed, those which are entirely or partially composed of particulate matter. These include ETS and combustion products from other sources, such as wood smoke or vehicle emissions, and also fibres, in particular, asbestos.

Objectives This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study. Methods The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors. Results In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs. Conclusions Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.

Tropospheric ozone threatens human health and crop yields, exacerbates global warming, and fundamentally changes atmospheric chemistry. Evidence has pointed toward widespread ozone increases in the troposphere, and particularly surface ozone is chemically complex and difficult to abate. Despite past successes in some regions, a solution to new challenges of ozone pollution in a warming climate remains unexplored. In this perspective, by compiling surface measurements at ∼4,300 sites worldwide between 2014 and 2019, we show the emerging global challenge of ozone pollution, featuring the unintentional rise in ozone due to the uncoordinated emissions reduction and increasing climate penalty. On the basis of shared emission sources, interactive chemical mechanisms, and synergistic health effects between ozone pollution and climate warming, we propose a synergistic ozone-climate control strategy incorporating joint control of ozone and fine particulate matter. This new solution presents an opportunity to alleviate tropospheric ozone pollution in the forthcoming low-carbon transition.

Background: Assessments of age-specifc mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Afairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specifc mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in diferent components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specifc mortality shows that there are remarkably complex patterns in population mortality across countries. The fndings of this study highlight global successes, such as the large decline in under-5 mortality, which refects signifcant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing.

Background: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.Methods: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.Findings: At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2–40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2–36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990—neonatal disorders, lower respiratory infections, and diarrhoeal diseases—were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases.Interpretation: Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.

The World Health Organisation declared the infectious spread of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) an epidemic during its initial outbreak in Wuhan (China) and has since declared it a pandemic and, more recently, an endemic infection that may remain in our communities. A vaccine for COVID-19 is expected to take several months, meaning that the spread may continue in future, in the absence of the most effective measures of social distancing and self-isolation. While these measures have worked well under lockdowns, the potential of airborne transmission of COVID-19 under the eased restrictions has not been considered important enough. We discuss the need to acknowledge the airborne spread of COVID-19 inside built spaces under eased movement restrictions and the potential steps that can be taken to control it.

Abstract Ever growing populations in cities are associated with a major increase in road vehicles and air pollution. The overall high levels of urban air pollution have been shown to be of a significant risk to city dwellers. However, the impacts of very high but temporally and spatially restricted pollution, and thus exposure, are still poorly understood. Conventional approaches to air quality monitoring are based on networks of static and sparse measurement stations. However, these are prohibitively expensive to capture tempo-spatial heterogeneity and identify pollution hotspots, which is required for the development of robust real-time strategies for exposure control. Current progress in developing low-cost micro-scale sensing technology is radically changing the conventional approach to allow real-time information in a capillary form. But the question remains whether there is value in the less accurate data they generate. This article illustrates the drivers behind current rises in the use of low-cost sensors for air pollution management in cities, while addressing the major challenges for their effective implementation.

Deterioration of air quality in Indian megacities (Delhi, Mumbai or Kolkata) is much more significant than that observed in the megacities of developed countries. Densely packed high-rise buildings restrict the self-cleaning capabilities of Indian megacities. Also, the ever growing number of on-road vehicles, resuspension of the dust, and anthropogenic activities exacerbate the levels of ambient air pollution, which is in turn breathed by urban dwellers. Pollution levels exceeding the standards on a regular basis often result in a notable increase in morbidity and mortality. This article discusses the challenges faced by Indian megacities in their quest for sustainable growth, without compromising the air quality and urban way of life.

Cities are constantly evolving and so are the living conditions within and between them. Rapid urbanization and the ever-growing need for housing have turned large areas of many cities into concrete landscapes that lack greenery. Green infrastructure can support human health, provide socio-economic and environmental benefits, and bring color to an otherwise grey urban landscape. Sometimes, benefits come with downsides in relation to its impact on air quality and human health, requiring suitable data and guidelines to implement effective greening strategies. Air pollution and human health, as well as green infrastructure and human health, are often studied together. Linking green infrastructure with air quality and human health together is a unique aspect of this article. A holistic understanding of these links is key to enabling policymakers and urban planners to make informed decisions. By critically evaluating the link between green infrastructure and human health via air pollution mitigation, we also discuss if our existing understanding of such interventions is enabling their uptake in practice. Both the natural science and epidemiology approach the topic of green infrastructure and human health very differently. The pathways linking health benefits to pollution reduction by urban vegetation remain unclear and that the mode of green infrastructure deployment is critical to avoid unintended consequences. Strategic deployment of green infrastructure may reduce downwind pollution exposure. However, the development of bespoke design guidelines is vital to promote and optimize greening benefits and measuring green infrastructure’s socio-economic and health benefits are key for their uptake. Greening cities to mitigate pollution effects is on the rise and these needs to be matched by scientific evidence and appropriate guidelines. We conclude that urban vegetation can facilitate broad health benefits, but there is little empirical evidence linking these benefits to air pollution reduction by urban vegetation, and appreciable efforts are needed to establish the underlying policies, design and engineering guidelines governing its deployment.

Most major cities around the world experience periods of elevated air pollution levels, which exceed international health-based air quality standards (Kumar et al., 2013). Although it is a global problem, some of the highest air pollution levels are found in rapidly expanding cities in India and China. The sources, emissions, transformations and broad effects of meteorology on air pollution are reasonably well accounted in air quality control strategies in many developed cities; however these key factors remain poorly constrained in the growing cities of countries with emerging economies. We focus here on Delhi, one of the largest global population centres, which faces particular air pollution challenges, now and in the future.

Household air pollution is ranked the 9th largest Global Burden of Disease risk (Forouzanfar et al., The Lancet 2015). People, particularly urban dwellers, typically spend over 90% of their daily time indoors, where levels of air pollution often surpass those of outdoor environments. Indoor air quality (IAQ) standards and approaches for assessment and control of indoor air require measurements of pollutant concentrations and thermal comfort using conventional instruments. However, the outcomes of such measurements are usually averages over long integrated time periods, which become available after the exposure has already occurred. Moreover, conventional monitoring is generally incapable of addressing temporal and spatial heterogeneity of indoor air pollution, or providing information on peak exposures that occur when specific indoor sources are in operation. This article provides a review of the new air pollution sensing methods to determine IAQ and discusses how real-time sensing could bring a paradigm shift in controlling the concentration of key air pollutants in billions of urban houses worldwide. However, we also show that besides the opportunities, challenges still remain in terms of maturing technologies, or data mining and their interpretation. Moreover, we discuss further research and essential development needed to close gaps between what is available today and needed tomorrow. In particular, we demonstrate that awareness of IAQ risks and availability of appropriate regulation are lagging behind the technologies.

Global climate change, demographic change and advancing mechanization of everyday life will go along with new ways of living. Temperature extremes, an ageing society and higher demands on a comfortable life will lead to the implementation of sensor based networks in order to create acceptable and improved living conditions. Originally, the idea of the smart home served primarily the efficient use of energy and the optimization of ventilation technology connected with new ways of constructing buildings (low-energy and passive houses, respectively). Today the term 'smart home' is also linked with the networking of home automation systems, home appliances and communications and entertainment electronics. Living in a smart home often makes also significant demands on the occupants who are required to drastically change some of their living habits. This review summarizes current findings on the effect of measured environmental parameters on indoor air quality, individual thermal comfort and living behavior in smart homes with focus on central Europe. A critical evaluation of available sensor technologies, their application in homes and data security aspects as well as limits and possibilities of current technologies to control particles and gaseous pollutants indoors is included. The review also considers the acceptance of smart technologies by occupants in terms of living habits, perceived indoor air quality and data security.

While the crushing of concrete gives rise to large quantities of coarse dust, it is not widely recognized that this process also emits significant quantities of ultrafine particles. These particles impact not just the environments within construction activities but those in entire urban areas. The origin of these ultrafine particles is uncertain, as existing theories do not support their production by mechanical processes. We propose a hypothesis for this observation based on the volatilisation of materials at the concrete fracture interface. The results from this study confirm that mechanical methods can produce ultrafine particles (UFP) from concrete, and that the particles are volatile. The ultrafine mode was only observed during concrete fracture, producing particle size distributions with average count median diameters of 27, 39 and 49 nm for the three tested concrete samples. Further volatility measurements found that the particles were highly volatile, showing between 60 and 95% reduction in the volume fraction remaining by 125 °C. An analysis of the volatile fraction remaining found that different volatile material is responsible for the production of particles between the samples.

Cars are a commuting lifeline worldwide, despite contributing significantly to air pollution. This is the first global assessment on air pollution exposure in cars across ten cities: Dhaka (Bangladesh); Chennai (India); Guangzhou (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Blantyre (Malawi); and Dar-es-Salaam (Tanzania). Portable laser particle counters were used to develop a proxy of car-user exposure profiles and analyse the factors affecting particulate matter ≤2.5 μm (PM2.5; fine fraction) and ≤10 μm (PM2.5–10; coarse fraction). Measurements were carried out during morning, off- and evening-peak hours under windows-open and windows-closed (fan-on and recirculation) conditions on predefined routes. For all cities, PM2.5 and PM10 concentrations were highest during windows-open, followed by fan-on and recirculation. Compared with recirculation, PM2.5 and PM10 were higher by up to 589% (Blantyre) and 1020% (São Paulo), during windows-open and higher by up to 385% (São Paulo) and 390% (São Paulo) during fan-on, respectively. Coarse particles dominated the PM fraction during windows-open while fine particles dominated during fan-on and recirculation, indicating filter effectiveness in removing coarse particles and a need for filters that limit the ingress of fine particles. Spatial variation analysis during windows-open showed that pollution hotspots make up to a third of the total route-length. PM2.5 exposure for windows-open during off-peak hours was 91% and 40% less than morning and evening peak hours, respectively. Across cities, determinants of relatively high personal exposure doses included lower car speeds, temporally longer journeys, and higher in-car concentrations. It was also concluded that car-users in the least affluent cities experienced disproportionately higher in-car PM2.5 exposures. Cities were classified into three groups according to low, intermediate and high levels of PM exposure to car commuters, allowing to draw similarities and highlight best practices.

Over the past decade, a range of sensor technologies became available on the market, enabling a revolutionary shift in air pollution monitoring and assessment. With their cost of up to three orders of magnitude lower than standard/reference instruments, many avenues for applications have opened up. In particular, broader participation in air quality discussion and utilisation of information on air pollution by communities has become possible. However, many questions have been also asked about the actual benefits of these technologies. To address this issue, we conducted a comprehensive literature search including both the scientific and grey literature. We focused upon two questions: (1) Are these technologies fit for the various purposes envisaged? and (2) How far have these technologies and their applications progressed to provide answers and solutions? Regarding the former, we concluded that there is no clear answer to the question, due to a lack of: sensor/monitor manufacturers’ quantitative specifications of performance, consensus regarding recommended end-use and associated minimal performance targets of these technologies, and the ability of the prospective users to formulate the requirements for their applications, or conditions of the intended use. Numerous studies have assessed and reported sensor/monitor performance under a range of specific conditions, and in many cases the performance was concluded to be satisfactory, e.g. (Castell et al. 2017, Han et al. 2017, Sousan et al. 2017). The specific use cases for sensors/monitors included outdoor in a stationary mode, outdoor in a mobile mode, indoor environments and personal monitoring. Under certain conditions of application, project goals, and monitoring environments, some sensors/monitors were fit for a specific purpose. Based on analysis of 17 large projects, which reached applied outcome stage, and typically conducted by consortia of organizations, we observed that a sizable fraction of them (~ 30%) were commercial and/or crowd-funded. This fact by itself signals a paradigm change in air quality monitoring, which previously had been primarily implemented by government organizations. An additional paradigm-shift indicator is the growing use of machine learning or other advanced data processing approaches to improve sensor/monitor agreement with reference monitors. There is still some way to go in enhancing application of the technologies for source apportionment, which is of particular necessity and urgency in developing countries. Also, there has been somewhat less progress in wide-scale monitoring of personal exposures. However, it can be argued that with a significant future expansion of monitoring networks, including indoor environments, there may be less need for wearable or portable sensors/monitors to assess personal exposure. Traditional personal monitoring would still be valuable where spatial variability of pollutants of interest is at a finer resolution than the monitoring network can resolve.

While concrete recycling is practiced worldwide, there are many unanswered questions in relation to ultrafine particle (UFP; Dp < 100 nm) emissions and exposure around recycling sites. In particular: (i) Does recycling produce UFPs and in what quantities? (ii) How do they disperse around the source? (iii) What impact does recycling have on ambient particle number concentrations (PNCs) and exposure? (iv) How effective are commonly used dust respirators to limit exposure? We measured size-resolved particles in the 5–560 nm range at five distances between 0.15 and 15.15 m that were generated by an experimentally simulated concrete recycling source and found that: (i) the size distributions were multimodal, with up to ∼93% of total PNC in the UFP size range; and (ii) dilution was a key particle transformation mechanism. UFPs showed a much slower decay rate, requiring ∼62% more distance to reach 10% of their initial concentration compared with their larger counterparts in the 100–560 nm size range. Compared with typical urban exposure during car journeys, exposure decay profiles showed up to ∼5 times higher respiratory deposition within 10 m of the source. Dust respirators were found to remove half of total PNC; however the removal factor for UFPs was only ∼57% of that observed in the 100–560 nm size range. These findings highlight a need for developing an understanding of the nature of the particles as well as for better control measures to limit UFP exposure.

The health of the city depends on how well all the elements of this system are interconnected and operating in harmony. Here the authors introduced the concept of urbanome which is analogous to the human genome that can be used to characterise the form and functioning of cities.

We critically assessed numerous aspects such as vehicle fleet, type of fuel used in road vehicles, their emissions and concentrations of particulate matter ≤2.5 µm (PM2.5) and ≤10 µm (PM10) in three of the most polluted metropolitan areas of Brazil: the Metropolitan areas of São Paulo (MASP), Rio de Janeiro (MARJ) and Belo Horizonte (MABH). About 90% of the Brazilian LDVs run on ethanol or gasohol. The HDVs form a relatively low fraction of the total fleet but account for 90% of the PM from road vehicles. Brazilian LDVs normally emit 0.0011g (PM) km-1 but HDVs can surpass 0.0120g (PM) km-1. The emission control programs (e.g., PROCONVE) have been successful in reducing the vehicular exhaust emissions, but the non-exhaust vehicular sources such, as evaporative losses during refueling of vehicles as well as wear from the tyre, break, and road surface have increased in line with the increase in the vehicle fleet. The national inventories show the highest annual mean PM2.5 (28.1μg m–3) in the MASP that has the largest vehicle fleet in the country. In general, the PM10 concentrations in the studied metropolitan areas appear to comply with the national regulations but were up to ~3-times above the WHO guidelines. The current Brazilian air quality standards are far behind the European standards. There has been a progress in bringing more restrictive regulations for air pollutants including PM10 and PM2.5 but such steps also require suitable solutions to control PM emissions from motor vehicles and mechanical processes.

Over the past decade, a range of sensor technologies became available on the market, enabling a revolutionary shift in air pollution monitoring and assessment. With their cost of up to three orders of magnitude lower than standard/reference instruments, many avenues for applications have opened up. In particular, broader participation in air quality discussion and utilisation of information on air pollution by communities has become possible. However, many questions have been also asked about the actual benefits of these technologies. To address this issue, we conducted a comprehensive literature search including both the scientific and grey literature. We focused upon two questions: (1) Are these technologies fit for the various purposes envisaged? and (2) How far have these technologies and their applications progressed to provide answers and solutions? Regarding the former, we concluded that there is no clear answer to the question, due to a lack of: sensor/monitor manufacturers' quantitative specifications of performance, consensus regarding recommended end-use and associated minimal performance targets of these technologies, and the ability of the prospective users to formulate the requirements for their applications, or conditions of the intended use. Numerous studies have assessed and reported sensor/monitor performance under a range of specific conditions, and in many cases the performance was concluded to be satisfactory. The specific use cases for sensors/monitors included outdoor in a stationary mode, outdoor in a mobile mode, indoor environments and personal monitoring. Under certain conditions of application, project goals, and monitoring environments, some sensors/monitors were fit for a specific purpose. Based on analysis of 17 large projects, which reached applied outcome stage, and typically conducted by consortia of organizations, we observed that a sizable fraction of them (~ 30%) were commercial and/or crowd-funded. This fact by itself signals a paradigm change in air quality monitoring, which previously had been primarily implemented by government organizations. An additional paradigm-shift indicator is the growing use of machine learning or other advanced data processing approaches to improve sensor/monitor agreement with reference monitors. There is still some way to go in enhancing application of the technologies for source apportionment, which is of particular necessity and urgency in developing countries. Also, there has been somewhat less progress in wide-scale monitoring of personal exposures. However, it can be argued that with a significant future expansion of monitoring networks, including indoor environments, there may be less need for wearable or portable sensors/monitors to assess personal exposure. Traditional personal monitoring would still be valuable where spatial variability of pollutants of interest is at a finer resolution than the monitoring network can resolve.

In the present study, the daily dose in terms of particle surface area received by citizens living in five cities in Western countries, characterized by different lifestyle, culture, climate and built-up environment, was evaluated and compared. For this purpose, the exposure to sub-micron particle concentration levels of the population living in Barcelona (Spain), Cassino (Italy), Guilford (United Kingdom), Lund (Sweden), and Brisbane (Australia) was measured through a direct exposure assessment approach. In particular, measurements of the exposure at a personal scale were performed by volunteers (15 per each population) that used a personal particle counter for different days in order to obtain exposure data in microenvironments/activities they resided/performed. Non-smoking volunteers performing non-industrial jobs were considered in the study. Particle concentration data allowed obtaining the exposure of the population living in each city. Such data were combined in a Monte Carlo method with the time activity pattern data characteristics of each population and inhalation rate to obtain the most probable daily dose in term of particle surface area as a function of the population gender, age, and nationality. The highest daily dose was estimated for citizens living in Cassino and Guilford (>1000 mm2), whereas the lowest value was recognized for Lund citizens (around 100 mm2). Indoor air quality, and in particular cooking and eating activities, was recognized as the main influencing factor in terms of exposure (and thus dose) of the population: then confirming that lifestyle (e.g. time spent in cooking activities) strongly affect the daily dose of the population. On the contrary, a minor or negligible contribution of the outdoor microenvironments was documented.

This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the COVID-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it. We alerted the World Health Organization about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue, and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.

In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544.9 million people (95% uncertainty interval [UI] 506.9- 584.8) worldwide had a chronic respiratory disease, representing an increase of 39.8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex- specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7.0% [95% UI 6.8-7 .2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578-4 044 819) in 2017, an increase of 18.0% since 1990, while total DALYs increased by 13.3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14.3% decrease), agestandardised death rates (42.6%), and age-standardised DALY rates (38.2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings: In 2016, HAQ Index performance spanned from a high of 97.1 (95% UI 95.8-98.1) in Iceland, followed by 96.6 (94.9-97.9) in Norway and 96.1 (94.5-97.3) in the Netherlands, to values as low as 18.6 (13.1-24.4) in the Central African Republic, 19.0 (14.3-23.7) in Somalia, and 23.4 (20.2-26.8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1-936) in Beijing to 48.0 (43.4-53.2) in Tibet (a 43.5-point difference), while India saw a 30.8-point disparity, from 64.8 (59.6-68.8) in Goa to 34.0 (30.3-38.1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4.8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20.9-point to 17.0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17.2-point to 20.4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view and subsequent provision of quality health care for all populations.

The small size and large surface area of ultrafine particles (UFP) enhance their ability to deposit in the lung periphery and their reactivity. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) cross-sectional study was conducted in 8-11-year-old schoolchildren attending 25 primary (elementary) schools, randomly selected from the Brisbane Metropolitan Area, Queensland, Australia. Main study findings outlined indirect evidence of distal airway deposition (raised C reactive protein) but as yet, there is no direct evidence in the literature of effects of UFP exposure on peripheral airway function. We present further UPTECH study data from two sensitive peripheral airway function tests, Oscillometry and Multiple Breath Nitrogen Washout (MBNW), performed in 577 and 627 children (88% and 96% of UPTECH study cohort) respectively: mean(SD) age 10.1(0.9) years, 46% male, with 50% atopy and 14% current asthma. Bayesian generalised linear mixed effects regression models were used to estimate the effect of UFP particle number count (PNC) exposure on key oscillometry (airway resistance, (Rrs), and reactance, (Xrs)) and MBNW (lung clearance index, (LCI) and func-tional residual capacity, (FRC)) indices. We adjusted for age, sex, and height, and potential confounders including socio-economic disadvantage, PM2.5 and NO2 exposure. All models contained an interaction term between UFP PNC exposure and atopy, allowing estimation of the effect of exposure on non-atopic and atopic students. Increasing UFP PNC was associated with greater lung stiffness as evidenced by a decrease in Xrs [mean (95% credible interval) 1.63 (3.36 to 0.05)%] per 1000#.cm3]. It was also associated with greater lung stiffness (decrease in Xrs) in atopic subjects across all models [mean change ranging from 2.06 to 2.40% per 1000#.cm3]. A paradoxical positive effect was observed for Rrs across all models [mean change ranging from 1.55 to 1.70% per 1000#.cm3] (decreases in Rrs indicating an increase in airway calibre), which was present for both atopic and non-atopic subjects. No effects on MBNW indices were observed. In conclusion, a modest detrimental effect of UFP on peripheral airway function among atopic subjects, as assessed by respiratory system reactance, was observed extending the main UPTECH study findings which reported a positive association with a biomarker for systemic inflammation, C-reactive protein (CRP). Further studies are warranted to explore the pathophysiological mechanisms underlying increased respiratory stiffness, and whether it persists through to adolescence and adulthood.

Pathways for China to achieve its dual targets of air quality and CO 2 mitigation in 2035 were investigated through a newly developed evaluation framework coupling integrated assessment and air quality models. Results indicate that the low-carbon energy policies, traditionally regarded as a primary result of climate mitigation, are likely driven more by the efforts on air quality attainment in China. To achieve air quality attainment in China could lead to more reduction in CO 2 emissions than its Nationally Determined Contribution. In addition, stronger low-carbon policies will bring significant benefits to public health via improvements in air quality. This study also provides a valuable reference for other developing countries to address their duel challenges of climate change and air pollution. China is challenged with the simultaneous goals of improving air quality and mitigating climate change. The “Beautiful China” strategy, launched by the Chinese government in 2020, requires that all cities in China attain 35 μg/m 3 or below for annual mean concentration of PM 2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) by 2035. Meanwhile, China adopts a portfolio of low-carbon policies to meet its Nationally Determined Contribution (NDC) pledged in the Paris Agreement. Previous studies demonstrated the cobenefits to air pollution reduction from implementing low-carbon energy policies. Pathways for China to achieve dual targets of both air quality and CO 2 mitigation, however, have not been comprehensively explored. Here, we couple an integrated assessment model and an air quality model to evaluate air quality in China through 2035 under the NDC scenario and an alternative scenario (Co-Benefit Energy [CBE]) with enhanced low-carbon policies. Results indicate that some Chinese cities cannot meet the PM 2.5 target under the NDC scenario by 2035, even with the strictest end-of-pipe controls. Achieving the air quality target would require further reduction in emissions of multiple air pollutants by 6 to 32%, driving additional 22% reduction in CO 2 emissions relative to the NDC scenario. Results show that the incremental health benefit from improved air quality of CBE exceeds 8 times the additional costs of CO 2 mitigation, attributed particularly to the cost-effective reduction in household PM 2.5 exposure. The additional low-carbon energy polices required for China’s air quality targets would lay an important foundation for its deep decarbonization aligned with the 2 °C global temperature target.

Studying the characteristics of new particle formation (NPF) is important as it is generally recognized as a major contributor to particle pollution in urban environments. We investigated NPF events that occurred during a 1-year period in the urban environment of Brisbane, Australia, using a neutral cluster and air ion spectrometer (NAIS) which is able to monitor both neutral and charged particles and clusters down to a size of 0.8 nm. NPF events occurred on 41% of days, with the occurrence rate of 7% greater in the summer than in the winter. We derived the first diurnal event distribution of NPF events anywhere in the world and showed that the most probable starting time of an NPF event was near 08:30 a.m., being about an hour earlier in the winter than in the summer. During NPF days, 10% of particles were charged. The mean neutral and charged particle concentrations on NPF days were, respectively, 49% and 14% higher than those on non-event days. The mean formation rate of 2-3 nm particles during an NPF event was 20.8 cm  s . The formation rate of negatively charged particles was about 10% higher than that of positively charged particles. The mean particle growth rate in the size range up to 20 nm was 6.2 nm h . These results are compared and contrasted with corresponding values that have been derived with the scanning mobility particle sizer (SMPS) at the same location and with values that have been reported with the NAIS at other locations around the world. This is the first comprehensive study of the characteristics of NPF events over a significantly long period in Australia.

•Maternal PM and NO2 exposure was associated with higher odds of CHD.•The first trimester might be the critical exposure window of air pollution for CHD.•Pattern of the associations of air pollutants with CHD subtypes was mixed. Evidence of maternal exposure to ambient air pollution on congenital heart defects (CHD) has been mixed and are still relatively limited in developing countries. We aimed to investigate the association between maternal exposure to air pollution and CHD in China. This longitudinal, population-based, case-control study consecutively recruited fetuses with CHD and healthy volunteers from 21 cities, Southern China, between January 2006 and December 2016. Residential address at delivery was linked to random forests models to estimate maternal exposure to particulate matter with an aerodynamic diameter of ≤ 1 µm (PM1), ≤2.5 µm, and ≤10 µm as well as nitrogen dioxides, in three trimesters. The CHD cases were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia ultrasound. The CHD subtypes were coded using the International Classification Diseases. Adjusted logistic regression models were used to assess the associations between air pollutants and CHD and its subtypes. A total of 7055 isolated CHD and 6423 controls were included in the current analysis. Maternal air pollution exposures were consistently higher among cases than those among controls. Logistic regression analyses showed that maternal exposure to all air pollutants during the first trimester was associated with an increased odds of CHD (e.g., an interquartile range [13.3 µg/m3] increase in PM1 was associated with 1.09-fold ([95% confidence interval, 1.01–1.18]) greater odds of CHD). No significant associations were observed for maternal air pollution exposures during the second trimester and the third trimester. The pattern of the associations between air pollutants and different CHD subtypes was mixed. Maternal exposure to greater levels of air pollutants during the pregnancy, especially the first trimester, is associated with higher odds of CHD in offspring. Further longitudinal well-designed studies are warranted to confirm our findings.

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

The way we produce and use energy is transforming. Policy in this area intersects decisions that affect climate change, air quality, and the economy. The exponential increase in use of fossil fuel and nuclear energy has now essentially replaced human and animal energy (McKinney 2019 Curr. Pollut. Rep. 5 394-406; Solomon and Krishna 2011 Energy Policy 39 7422-31). These transitions have contributed to notable gains, such as improvements in mortality rates attributable to improved heating, water quality and transportation (Rayner 2012 Ecological Public Health : Reshaping the Conditions for Good health/Geof Rayner and Tim Lang (Abingdon, Oxon: Earthscan); Rosen 2015 A History of Public Health (Jhu Press); Pain 2017 Nature 551 S134-7; Cutler and Miller 2005 Demography 42 1-22). However, such transitions have also been accompanied by health detriments. Improvements in transportation and occupational efficiencies have promoted lifestyle transitions that have contributed to the chronic disease epidemic (Heath 2009 Am. J. Lifestyle Med. 3 27S-31S). Certain energy-related accidents and waste products have been long-established as carcinogenic (Guizard et al 2001 J. Epidemiol. Community Health 55 469; Cardis and Hatch 2011 Clin. Oncol. 23 251-60) and potential precursors to genetic mutations (Beir 1990 Health Effects of Exposure to Low Levels of Ionizing Radiation (Washington, DC: National Academy of Sciences); Desouky et al 2015 J. Radiat. Res. Appl. Sci. 8 247-54). Moreover, air pollution emissions are increasingly becoming recognised as a major contributor the global burden of disease, particularly cardiovascular and respiratory mortality (Cohen et al 2017 Lancet 389 1907-18). Although renewable energies can be perceived as 'clean', the shift to renewables has been relatively more recent and consequently, less is known about associated health impacts. The life course of renewable energy begins with the process of manufacturing renewable technologies, includes the means of transportation for the distribution and collection of these technologies as well as the disposal of their waste products and subsequent contamination. All of these stages have potential to involve direct chemical exposures through the groundwater, soil or air; and have potential to affect health through indirect pathways. A relatively understudied area, and the topic of this Focus Issue on Energy Transitions, Air Quality and Health, is the relevance of energy transitions and their associated environmental factors in a contemporary setting, how such factors affect health now, and will affect health in future.

The diurnal variation of pollutants such as particles and carbon monoxide (CO) in urban environments typically follow the traffic density, with two peaks coinciding with the weekday morning and evening rush-hour periods. However, observations made in central Brisbane, the third largest city in Australia, demonstrated an anomalous diurnal variation with the CO peak in the evening being significantly higher than that in the morning. This imbalance was not observed for particle concentrations. Here, we show that the imbalance is a direct result of the difference in CO emission factors from motor vehicles during warm and cold starts. Over 30,000 cars with warmed-up engines enter Brisbane city centre car parks every weekday morning. They all start their engines from cold and leave the city in the evening, producing the anomalously higher emissions of CO in the city centre. This pattern of air quality, while clearly apparent within the city car parks and within the central business district of the city, was not observed outside the city limits and in the suburbs. To the best of our knowledge, no previous study has drawn attention to this phenomenon and no explanation has been provided in the literature to-date. [Display omitted] •Diurnal variation of carbon monoxide (CO) and PM2.5 concentrations in a city center .•Both concentrations exhibit two peaks coinciding with rush hour traffic periods .•However, the CO peak in the afternoon is significantly higher than in the morning .•This latter phenomenon has not been noticed or reported before .•The effect is attributed to excessive cold start emissions from motor vehicles .

Shipping emissions are known to affect communities in coastal locations, especially near harbours. This study monitored the air quality near the premier cruise ship terminal in Melbourne over a continuous period of 98 days during the peak cruise ship season in Australia. As shipping emission plumes are intermittent and fluctuate spatially, they cannot be detected accurately by a single fixed monitor. To overcome this limitation, we deployed seven units of the low-cost KOALA air quality monitor, which measures PM2.5 and CO concentrations in real time and then transmits the data via 3G to an in-cloud database, in a spatially distributed configuration, four at ground level and three on the upper balconies of two high-rise apartment blocks. The time profile showed numerous spikes in the PM2.5 concentration, some of which exceeded 200 mu g m(-3) for periods of 5-10 min, coinciding with ship movements. On average, the spikes were similar to 4-5 times above the normal background value (similar to 10 mu g m(-3)). Because of their very short duration, these episodes did not significantly raise the 24-h averages at any of the locations; however, they increased the number of days on which these values exceeded the limit specified by the national air quality standard, resulting in more exceedance days for the monitored area than the nearest air quality station. Although the long-term health effects of elevated PM concentrations are known, few studies have been conducted on the risks of short-term exposures to extreme spikes.

Objectives This study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study. Methods The burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs). Results There were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens-3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 -79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (-10%) and DALYs (-15%) due to exposure to occupational carcinogens. Conclusions Work-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.

Healthcare-acquired infections (HAIs) continue to persist in hospitals, despite the use of increasingly strict infection-control precautions. Opportunistic airborne transmission of potentially pathogenic bioaerosols may be one possible reason for this persistence. Therefore, this study aimed to systematically review the concentrations and compositions of indoor bioaerosols in different areas within hospitals and the effects of different ventilation systems. Electronic databases (Medline and Web of Science) were searched to identify articles of interest. The search was restricted to articles published from 2000 to 2017 in English. Aggregate data was used to examine the differences in mean colony forming units per cubic metre (cfu/m(3)) between different hospital areas and ventilation types. A total of 36 journal articles met the eligibility criteria. The mean total bioaerosol concentrations in the different areas of the hospitals were highest in the inpatient facilities (77 cfu/m(3), 95% confidence interval (CI): 55-108) compared with the restricted (13cfu/m(3), 95% CI: 10-15) and public areas (14 cfu/m(3), 95% CI: 10-19). Hospital areas with natural ventilation had the highest total bioaerosol concentrations (201 cfu/m(3), 95% CI: 135-300) compared with areas using conventional mechanical ventilation systems (20 cfu/m(3), 95% CI: 16-24). Hospital areas using sophisticated mechanical ventilation systems (such as increased air changes per hour, directional flow and filtration systems) had the lowest total bioaerosol concentrations (9 cfu/m(3), 95% CI: 7-13). Operating sophisticated mechanical ventilation systems in hospitals contributes to improved indoor air quality within hospitals, which assists in reducing the risk of airborne transmission of HAIs. Crown Copyright (C) 2019 Published by Elsevier Ltd on behalf of The Healthcare Infection Society. All rights reserved.

Emissions of hazardous organic chemicals from crumb rubber modified (CRM) asphalt mixes have been longstanding environmental and occupational health concerns. This study aimed to quantify the emissions of volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs) and total suspended particles (TSP) from CRM and polymer asphalt mixes. Occupational exposure, during paving construction activities, to particulate matter (PM) in different size was also evaluated for pavement workers by a personal exposure monitoring approach. Overall, chamber test results showed that CRM hot mix asphalt (C-HMA) emitted higher levels of VOCs and PAHs than CRM warm mix asphalt (C-WMA), whereas C-WMA emitted a higher level of TSP. Lighter PAHs dominated the emitted ∑12 PAHs in both C-HMA and C-WMA, but compositions of VOCs varied greatly between asphalt groups. The emission factors for TSP and PAHs were 110 and 2.6 μg/kg asphalt for C-HMA, and 260 and 1.3 μg/kg asphalt for C-WMA, respectively. In addition, personal exposure level of PM was overall below the exposure guideline for asphalt fumes. The results from this study are expected to contribute to a comprehensive risk assessment of using ground tyre rubber techniques in road paving industries. •CRM asphalt in warm mix produced less emissions of PAHs and VOCs than hot mix.•Generally lower emissions of VOCs and PAHs were associated with lower temperature.•Most PAHs emitted from asphalt mixes were 3–4 rings and not carcinogenic.•The level of personal exposure of particles was below the exposure limit.

[Display omitted] •Predictive estimation approach improves airborne infection risk assessment methods.•SARS-CoV-2 estimated to be nearly as contagious as Mycobacterium tuberculosis.•SARS-CoV-2 much more transmissible through indoor air than seasonal influenza.•Current ventilation standards in public buildings are unlikely to control SARS-CoV-2. The infectious emission rate is a fundamental input parameter for airborne transmission risk assessment, but data are limited due to reliance on estimates from chance superspreading events. This study assesses the strength of a predictive estimation approach developed by the authors for SARS-CoV-2 and uses novel estimates to compare the contagiousness of respiratory pathogens. We applied the approach to SARS-CoV-1, SARS-CoV-2, MERS, measles virus, adenovirus, rhinovirus, coxsackievirus, seasonal influenza virus and Mycobacterium tuberculosis (TB) and compared quanta emission rate (ERq) estimates to literature values. We calculated infection risk in a prototypical classroom and barracks to assess the relative ability of ventilation to mitigate airborne transmission. Our median standing and speaking ERq estimate for SARS-CoV-2 (2.7 quanta h−1) is similar to active, untreated TB (3.1 quanta h−1), higher than seasonal influenza (0.17 quanta h−1), and lower than measles virus (15 quanta h−1). We calculated event reproduction numbers above 1 for SARS-CoV-2, measles virus, and untreated TB in both the classroom and barracks for an activity level of standing and speaking at low, medium and high ventilation rates of 2.3, 6.6 and 14 L per second per person (L s–1 p–1), respectively. Our predictive ERq estimates are consistent with the range of values reported over decades of research. In congregate settings, current ventilation standards are unlikely to control the spread of viruses with upper quartile ERq values above 10 quanta h−1, such as SARS-CoV-2, indicating the need for additional control measures.

The toxicity of ultrafine particles (UFPs) on blood pressure (BP) has not been well studied. We aimed to evaluate the associations of long-term UFP exposure with different components of BP and the risk of prehypertension/hypertension. We included a total of 24 845 Chinese adults (18-74 years old) in a cross-sectional survey (Liaoning province, China). The 4 year (2006-2009) average concentrations of UFP was estimated using a chemical transport model. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP), prehypertension and hypertension. We used a generalized linear mixed model to examine the associations while controlling for important individual covariates. One unit (1 mu g m(-3)) increase in UFP was associated with an increase in SBP of 1.52 mm Hg [95% confidence interval (CI): 0.48-2.55], DBP of 0.55 mm Hg (95% CI: 0.01-1.08) in DBP, MAP of 0.92 mm Hg (95% CI: 0.23-1.61) and PP of 0.62 mm Hg (95% CI: 0.05-1.20). The UFP-BP associations were stronger in women than in men. One unit increase in UFP was associated with an increased risk of hypertension and prehypertension (OR = 1.23, 95% CI: 1.09-1.38; OR = 1.12, 95% CI: 1.04-1.21) compared to normotension group, and these associations were stronger in overweight/obese participants. Our study showed that long-term exposure to UFP was associated with elevated BP and higher odds of hypertension. These findings suggest that strategies to monitor and reduce UFPs, which are not a regulated pollutant, could have beneficial cardiovascular effects.

Coronavirus disease 2019 (COVID-19) patients exhaled millions of severe acute respiratory syndrome coronavirus 2 RNA copies per hour, which plays an important role in COVID-19 transmission. Exhaled breath had a higher positive rate (26.9%, n = 52) than surface (5.4%, n = 242) and air (3.8%, n = 26) samples.

Objectives This paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study. Methods The burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above. Results The estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%-20%) for COPD and 10% (95% UI 9%-11%) for asthma. There were estimated to be 519 000 (95% UI 441,000-609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000-551,000]; asthma: 37,600 [95% UI 28,400-47,900]; pneumoconioses: 21,500 [95% UI 17,900-25,400]. The equivalent overall burden estimate was 13.6 million (95% UI 11.9-15.5 million); DALYs (COPD: 10.7 [95% UI 9.0-12.5] million; asthma: 2.3 [95% UI 1.9-2.9] million; pneumoconioses: 0.58 [95% UI 0.46-0.67] million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-S aharan Africa; and decreased from 1990 to 2016. Conclusions Workplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures.

[This corrects the article DOI: 10.1016/S0140-6736(18)32203-7.].

This research demonstrates the use of an unmanned aerial vehicle (UAV) to characterize the gaseous (CO2) and particle (10-500 nm) emissions of a ship at sea. The field study was part of the research voyage "The Great Barrier Reef as a significant source of climatically relevant aerosol particles" on board the RV Investigator around the Australian Great Barrier Reef. Measurements of the RV Investigator exhaust plume were carried out while the ship was operating at sea, at a steady engine load of 30 %. The UAV system was flown autonomously using several different programmed paths. These incorporated different altitudes and distances behind the ship in order to investigate the optimal position to capture the ship plume. Five flights were performed, providing a total of 27 horizontal transects perpendicular to the ship exhaust plume. Results show that the most appropriate altitude and distance to effectively capture the plume was 25ma.s.1. and 20 m downwind. Particle number emission factors (EF(PN)s) were calculated in terms of number of particles emitted (no.) per weight of fuel consumed (kg(fuel)). Fuel consumption was calculated using the simultaneous measurements of plume CO2 concentration. The calculated EFPN was 7.6 +/- 1.4 x 10(15) no. kg(fuel)(-1) which is in line with those reported in the literature for ship emissions ranging from 0.2 to 6.2 x 10(16) no. kg(fuel)(-1). This UAV system successfully assessed ship emissions to derive EFPN under real world conditions. This is significant as it provides a novel, relatively inexpensive and accessible way to assess ship EFPN at sea.

In this study, the risk of infection from SARS-CoV-2 Delta variant of passengers sharing a car cabin with an infected subject for a 30-min journey is estimated through an integrated approach combining a recently developed predictive emission-to-risk approach and a validated CFD numerical model numerically solved using the opensource OpenFOAM software. Different scenarios were investigated to evaluate the effect of the infected subject position within the car cabin, the airflow rate of the HVAC system, the HVAC ventilation mode, and the expiratory activity (breathing vs. speaking). The numerical simulations here performed reveal that the risk of infection is strongly influenced by several key parameters: As an example, under the same ventilation mode and emitting scenario, the risk of infection ranges from zero to roughly 50% as a function of the HVAC flow rate. The results obtained also demonstrate that (i) simplified zero-dimensional approaches limit proper evaluation of the risk in such confined spaces, conversely, (ii) CFD approaches are needed to investigate the complex fluid dynamics in similar indoor environments, and, thus, (iii) the risk of infection in indoor environments characterized by fixed seats can be in principle controlled by properly designing the flow patterns of the environment.

Two proposed quartz fibrous filters with dissimilar solid volume fractions and thicknesses are investigated for their efficiency in removing soot aerosol particles from air. Soot particles are sourced from a candle burning in a chamber, and the tests involve 1.5 h of continuous loading of particles at three different flow rates: 4.5, 8.15 and 9.55 l/min. The fractional efficiency, morphology and pressure drop of both clean and loaded filters are studied using a scanning mobility particle sizer, scanning electron microscope and differential pressure gauge. Both filters have relatively similar levels of efficiency 93% for particle size (100-400 nm) at the lowest flow rate. At higher flow rates, the re-entrainment process effects the filtration efficiency of both filters. At the higher flow rate of 8.15 l/min, the filter with a higher solid volume fraction and thickness shows a higher pressure drop and an efficiency level of 95%. Increasing the flow rate to 9.55 l/min helps to pass the particles with diameters larger than 100 nm through two filters. This phenomenon decreases the fractional efficiency of both filters during the loading time.

A paradigm shift to the use of indoor rather than outdoor temperature to estimate the exposure risk of low and high temperatures is vital for better prediction of temperature health effects and timely health warnings, and will also assist in understanding the influence of temperature on energy consumption and comfort. This study aimed to quantify the percentage of hours during the year that indoor temperature (living room) was in the extended comfort band (18-28 degrees C) of a subtropical climate, and identify the diurnal pattern of indoor temperatures in different seasons. Data used was collected in a previous study on the association between indoor and outdoor temperature. A k-shape cluster analysis resulted in two clusters of indoor temperature patterns for both weekdays and weekends. A bimodal pattern was identified during the cool season and a flat top pattern for the warm season, with many variations at weekends. These patterns can be attributed to the influence of cooling and heating processes depending on the season as well as occupancy, occupants' interference, and building materials. During the intermediate season, a sinusoidal pattern was observed for both weekdays and weekends because occupants likely relied on outdoor temperature conditions which were similar to those expected indoors without heating or cooling devices. The percentage of hours in which the indoor temperature of the houses ranged within the extended comfort band was 72-97% throughout the year, but for the coldest and hottest months it was 50-75%. These findings show that Brisbane residents are at possible risk of exposure to cold and hot temperatures due to the poor thermal performance of houses, and confirm that there is no standard indoor temperature pattern for all houses. (C) 2019 Elsevier B.V. All rights reserved.

Existing evidence is scarce concerning the various effects of different PM sizes and chemical constituents on blood lipids. A panel study that involved 88 healthy college students with five repeated measurements (440 blood samples in total) was performed. We measured mass concentrations of particulate matter with diameters ≤ 2.5 μm (PM ), ≤1.0 μm (PM ), and ≤0.5 μm (PM ) as well as number concentrations of particulate matter with diameters ≤ 0.2 μm (PN ) and ≤0.1 μm (PN ). We applied linear mixed-effect models to assess the associations between short-term exposure to different PM size fractions and PM constituents and seven lipid metrics. We found significant associations of greater concentrations of PM in different size fractions within 5 days before blood collection with lower high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A (ApoA1) levels, higher apolipoprotein B (ApoB) levels, and lower ApoA1/ApoB ratios. Among the PM constituents, we observed that higher concentrations of tin and lead were significantly associated with decreased HDL-C levels, and higher concentrations of nickel were associated with higher HDL-C levels. Our results suggest that short-term exposure to PM in different sizes was deleteriously associated with blood lipids. Some constituents, especially metals, might be the major contributors to the detrimental effects.

To investigate the atmospheric oxidative capacity (AOC) in forested high mountain areas adjacent to the photochemistry-active Pearl River Delta (PRD) region in southern China, one-month online observations of isoprene and its oxidation products methyl vinyl ketone (MVK) and methacrolein (MACR) were conducted at a national background station in Nanling Mountains in summer 2016. The results showed that the observed daytime isoprene levels (377 +/- 46 pptv) were significantly lower in comparison with other forest sites within and outside China, although the sampling site was surrounded with subtropical evergreen broad-leaved trees which are strong isoprene emitters. Also, high daytime (MVK MACR)/isoprene ratios (1.9 +/- 0.5) were observed. Based on the observations, we hypothesized that the lower isoprene levels in the study forest might be attributable to a strong AOC in relation to the elevated regional complex air pollution. In further data analyses, high site-level concentrations of daytime OH (7.3 +/- 0.5 x 10(6) molecules cm(-3)) and nighttime NO3 radicals (6.0 +/- 0.5 x 10(8) molecules cm(-3)) were estimated by using a photochemical box model incorporating the master chemical mechanism (PBM-MCM), and high regional mixing ratios of OH (19.7 +/- 2.3 x 10(6) molecules cm(-3)) during 09:00-15:00 LT were also obtained by applying a parameterization method with measured aromatic hydrocarbons. And besides, high initial mixing ratios (1213 +/- 108 pptv) and short atmospheric reaction time (0.27 h) of isoprene during the day were derived by a sequential reaction approach. All these indicate that isoprene was rapidly and highly oxidized in this forest, which supports our hypothesis. The study suggests that the complex air pollution in the PRD may have significantly elevated the background AOC of the adjacent forests, and probably affects the regional air quality and ecological environment in the long term. The feedback of forest ecosystems to the increasing AOC in southern China warrants further studies.

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

Detail characterization of particle size distribution and its temporal evolution is one of the critical elements towards uncovering mechanisms behind haze formation, yet rarely conducted. To address this deficiency, we conducted comprehensive characterization of particle size distribution during winter in Xi'an, China. Real-time measurements were conducted using a TSI Fast Mobility Particle Sizer Model 3091 (FMPS, from 5.6 to 523 nm) in the Qujiang campus of Xi'an Jiaotong University in the period from December 4th, 2015 to January 8th, 2016. The FMPS readings were adjusted by factors derived from an intercomparison with a TSI Scanning Mobility Particle Sizer (consisting of a TSI DMA 3081 and a CPC 3772, from 15.1 to 850.8 nm). Seven haze episodes and two new particle formation episodes were recorded during the sampling campaign. Two (E1 and E6) of the seven haze episodes are investigated in this study. E1 was an prolonged episode starting from a new particle formation (NPF) episode, followed by low, sustained PM2.5 increase at an average growth rate of 2 mu g m(-3) per hour (from 37 mu g m(-3) to 262 mu g m(-3) within 155 h), while E6 was a short-term haze episode starting from a rapid increase in PM2.5 at an rapid growth rate of 27 mu g m(-3) (from 79 mu g m(-3) to 213 mu g m(-3) within only 5 h). The average total particle number concentrations (PNC) were 3.35 x 10(4) cm(-3), 4.14 x 10(4) cm(-3) and 3.99 x 10(4) cm(-3) during normal days, E1, and E6, respectively, showing an increase in particle number concentration from normal days to haze days (p < .000 for E1 and p < .002 for E6, two-tailed t-test). While statically significant, the magnitude of the increase was not as large as of the increase in PM2.5 concentration. On normal days, the peak in particle number size distribution (PNSD) was centered at smaller particle sizes (around 60-70 nm, computed based on a normal distribution) and shifted towards larger sizes during the night (139 nm at 0:00 and 168 nm at 4:00 am). The diurnal variations of PNSD during E1 and E6 episodes were not as evident as the variations on normal days, with the centers of the major peaks at 179 nm for E1 and 137 nm for E6. It was found that significant changes in PNC and PNSD occurred during the PM (2.5) increase phase of severe haze episodes, but not during the high concentration phase. Since the growth rates of PM2.5 varied during increase phase between E1 and E6, PM2.5 pollution formation mechanisms were different throughout evaluating growth rates as it relates to PM2.5, gaseous pollutants, PNC, PNSD, and meteorological variables in these processes.

Background: Ambient air pollution exposure and influenza virus infection have been documented to be independently associated with reduced lung function previously. Influenza vaccination plays an important role in protecting against influenza-induced severe diseases. However, no study to date has focused on whether influenza vaccination may modify the associations between ambient air pollution exposure and lung function. Methods: We undertook a cross-sectional study of 6740 children aged 7-14 years into Seven Northeast Cities (SNEC) Study in China during 2012-2013. We collected information from parents/guardians about sociodemographic factors and influenza vaccination status in the past three years. Lung function was measured using portable electronic spirometers. Machine learning methods were used to predict 4-year average ambient air pollutant exposures to nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter < 1 mu m (PM1), < 2.5 mu m (PM2.5) and < 10 mu m (PM10). Two-level linear and logistic regression models were used to assess interactions between influenza vaccination and long-term ambient air pollutants exposure on lung function reduction, controlling for potential confounding factors. Results: Ambient air pollution were observed significantly associated with reductions in lung function among children. We found significant interactions between influenza vaccination and air pollutants on lung function, suggesting greater vulnerability to air pollution among unvaccinated children. For example, an interaction (p(interaction) = 0.002) indicated a - 283.44 mL (95% CI: - 327.04, - 239.83) reduction in forced vital capacity (FVC) per interquartile range (IQR) increase in PK_ concentrations among unvaccinated children, compared with the -108.24 mL (95%CI: - 174.88, - 41.60) reduction in FVC observed among vaccinated children. Results from logistic regression models also showed stronger associations between per IQR increase in PM1 and lung function reduction measured by FVC and peak expiratory flow (PEF) among unvaccinated children than the according ORs among vaccinated children [i.e., Odds Ratio (OR) for PM1 and impaired FVC: 2.33 (95%CI: 1.79, 3.03) vs 1.65 (95%CI: 1.20, 2.28); OR for PM2.5 and impaired PEF: 1.45 (95%CI: 1.12,1.87) vs 1.04 (95%CI: 0.76,1.43)]. The heterogeneity of the modification by influenza vaccination of the associations between air pollution exposure and lung function reduction appeared to be more substantial in girls than in boys. Conclusion: Our results suggest that influenza vaccination may moderate the detrimental effects of ambient air pollution on lung function among children. This study provides new insights into the possible co-benefits of strengthening and promoting global influenza vaccination programs among children.

The aim of this review was to investigate human exposure to relevant indoor air contaminants, predictors affecting the levels, and the means to reduce the harmful exposure in indoor sports facilities. Our study revealed that the contaminants of primary concern are the following: particulate matter in indoor climbing, golf, and horse riding facilities; carbon dioxide and particulate matter in fitness centers, gymnasiums, and sports halls; Staphylococci on gymnasium surfaces; nitrogen dioxide and carbon monoxide in ice hockey arenas; carbon monoxide, nitrogen oxide(s), and particulate matter in motor sports arenas; and disinfection by‐products in indoor chlorinated swimming pools. Means to reduce human exposure to indoor contaminants include the following: adequate mechanical ventilation with filters, suitable cleaning practices, a limited number of occupants in fitness centers and gymnasiums, the use of electric resurfacers instead of the engine powered resurfacers in ice hockey arenas, carefully regulated chlorine and temperature levels in indoor swimming pools, properly ventilated pools, and good personal hygiene. Because of the large number of susceptible people in these facilities, as well as all active people having an increased respiratory rate and airflow velocity, strict air quality requirements in indoor sports facilities should be maintained.

While low-cost particle sensors are increasingly being used in numerous applications, most of them have no heater or dryer at the inlet to remove water from the sample before measurement. Deliquescent growth of particles and the formation of fog droplets in the atmosphere can lead to significant increases in particle number concentration (PNC) and mass concentrations reported by such sensors. We carried out a detailed study using a Plantower PMS1003 low-cost particle sensor, both in the laboratory and under actual ambient field conditions, to investigate its response to increasing humidity and the presence of fog in the air. We found significant increases in particle number and mass concentrations at relative humidity above about 75 %. During a period of fog, the total PNC increased by 28 %, while the PNC larger than 2.5 pm increased by over 50 %. The PM10 concentration reported by the PMS1003 was 46 % greater than that on the standard monitor with a charcoal dryer at the inlet. While there is a causal link between particle pollution and adverse health effects, the presence of water on the particles is not harmful to humans. Therefore, air quality standards for particles are specifically limited to solid particles and standard particle monitoring instruments are fitted with a heater or dryer at the inlet to remove all liquid material from the sample before the concentrations are measured. This study shows that it is important to understand that the results provided by low-cost particle sensors, such as the PMS1003, cannot be used to ascertain if air quality standards are being met.

The airborne transmission of SARS-CoV-2 remains surprisingly controversial; indeed, health and regulatory authorities still require direct proof of this mode of transmission. To close this gap, we measured the viral load of SARS-CoV-2 of an infected subject in a hospital room (through an oral and nasopharyngeal swab), as well as the airborne SARS-CoV-2 concentration in the room resulting from the person breathing and speaking. Moreover, we simulated the same scenarios to estimate the concentration of RNA copies in the air through a novel theoretical approach and conducted a comparative analysis between experimental and theoretical results. Results showed that for an infected subject's viral load ranging between 2.4 × 106 and 5.5 × 106 RNA copies mL-1, the corresponding airborne SARS-CoV-2 concentration was below the minimum detection threshold when the person was breathing, and 16.1 (expanded uncertainty of 32.8) RNA copies m-3 when speaking. The application of the predictive approach provided concentrations metrologically compatible with the available experimental data (i.e. for speaking activity). Thus, the study presented significant evidence to close the gap in understanding airborne transmission, given that the airborne SARS-CoV-2 concentration was shown to be directly related to the SARS-CoV-2 emitted. Moreover, the theoretical analysis was shown to be able to quantitatively link the airborne concentration to the emission. [Display omitted] •The airborne transmission of SARS-CoV-2 remains surprisingly controversial.•A direct proof of SARS-CoV-2 airborne transmission is still required.•The link between emission and airborne concentration is experimentally demonstrated.•A theoretical approach estimating SARS-CoV-2 airborne concentrations is validated.•The measurement of airborne SARS-CoV-2 concentration presents high uncertainties.

Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and adolescents. A cross-sectional study was investigated during 2012–2013 in 94 schools from Seven Northeastern Cities (SNEC) in China. Questionnaires surveys were obtained from 56 137 children and adolescents aged 2–17 years. Influenza vaccination was defined as receipt of the influenza vaccine. We estimated air pollutants exposure [nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤1 μm (PM1), ≤2.5 μm (PM2.5) and ≤10 μm (PM10)] using machine learning methods. We employed two-level generalized linear mix effects model to examine interactive effects between influenza vaccination and air pollution exposure on allergic respiratory diseases (asthma, asthma-related symptoms and allergic rhinitis), after controlling for important covariates. We found statistically significant interactions between influenza vaccination and air pollutants on allergic respiratory diseases and related symptoms (doctor-diagnosed asthma, current wheeze, wheeze, persistent phlegm and allergic rhinitis). The adjusted ORs for doctor-diagnosed asthma, current wheeze and allergic rhinitis among the unvaccinated group per interquartile range (IQR) increase in PM1 and PM2.5 were significantly higher than the corresponding ORs among the vaccinated group [For PM1, doctor-diagnosed asthma: OR: 1.89 (95%CI: 1.57–2.27) vs 1.65 (95%CI: 1.36–2.00); current wheeze: OR: 1.50 (95%CI: 1.22–1.85) vs 1.10 (95%CI: 0.89–1.37); allergic rhinitis: OR: 1.38 (95%CI: 1.15–1.66) vs 1.21 (95%CI: 1.00–1.46). For PM2.5, doctor-diagnosed asthma: OR: 1.81 (95%CI: 1.52–2.14) vs 1.57 (95%CI: 1.32–1.88); current wheeze: OR: 1.46 (95%CI: 1.21–1.76) vs 1.11 (95%CI: 0.91–1.35); allergic rhinitis: OR: 1.35 (95%CI: 1.14–1.60) vs 1.19 (95%CI: 1.00–1.42)]. The similar patterns were observed for wheeze and persistent phlegm. The corresponding p values for interactions were less than 0.05, respectively. We assessed the risks of PM1-related and PM2.5-related current wheeze were decreased by 26.67% (95%CI: 1.04%–45.66%) and 23.97% (95%CI: 0.21%–42.08%) respectively, which was attributable to influenza vaccination (both p for efficiency

Background: Although nitrogen dioxide (NO2) is one of the most common air pollutants encountered indoors, and extensive literature has examined the link between NO2 exposure and duration causing adverse respiratory effects in susceptible populations, information about global and local exposure to NO2 in different indoor environments is limited. To synthesize the existing knowledge, this review analyzes the magnitude of and the trends in global and local exposure to NO2 in schools and offices, and the factors that control exposure. Methods: For the literature review, Web of Science, SCOPUS, Google Scholar, and PubMed were searched using 42 search terms and their combinations to identify manuscripts, reports, and directives published between 1971 and 2019. The search was then extended to the reference lists of relevant articles. Results: The calculated median, as well as the mean, concentration of NO2 in school (median 21.1 mu g/m(3); mean 29.4 mu g/m(3)) and office settings (median 22.7 mu g/m(3); mean 25.1 mu g/m(3)) was well below the World Health Organization (WHO) guideline of 40 mu g/m(3) for the annual mean NO2 concentration. However, a large range of average concentrations of NO2 were reported, from 6.00 to 68.5 mu g/m(3) and from 3.40 to 56.5 mu g/m(3) for school and office environments, respectively, indicating situations where the WHO guidelines are exceeded. Outdoor levels of NO2 are a reliable predictor of indoor NO2 levels across seasons, with mean and median Indoor/Outdoor (I/O) ratios of 0.9 and 0.7 in school and 0.9 and 0.8 in office environments, respectively. The absence of major indoor NO2 emission sources and NO2 sinks, including chemical reactions and deposition, are the reasons for lower indoor NO2 concentrations. During the winter, outdoor NO2 concentrations are generally higher than during the summer. In addition, various building and indoor environment characteristics, such as type of ventilation, air exchange rates, airtightness of the envelope, furnishing and surface characteristics of the building, location of the building (urban versus suburban and proximity to traffic routes), as well as occupants' behavior (such as opening windows), have been statistically significantly associated with indoor NO2 levels in school and office environments. Conclusions: Indoor exposure to NO2 from the infiltration of ambient air can be significant in urban areas, and in the case of high traffic volume. Although reducing transportation emissions is challenging, there are several easier means to reduce indoor NO2 concentrations, including a ventilation strategy with suitable filters; location planning of new schools, classrooms, and ventilating windows or intakes; traffic planning (location and density); and reducing the use of NO2-releasing indoor sources.

A new design method is proposed to calculate outdoor air ventilation rates to control respiratory infection risk in indoor spaces. We propose to use this method in future ventilation standards to complement existing ventilation criteria based on the perceived air quality and pollutant removal. The proposed method makes it possible to calculate the required ventilation rate at a given probability of infection and quanta emission rate. Present work used quanta emission rates for SARS-CoV-2 and consequently the method can be applied for other respiratory viruses with available quanta data. The method was applied to case studies representing typical rooms in public buildings. To reduce the probability of infection, the total airflow rate per infectious person revealed to be the most important parameter to reduce the infection risk. Category I ventilation rate prescribed in the EN 16798-1 standard satisfied many but not all type of spaces examined. The required ventilation rates started from about 80 L/s per room. Large variations between the results for the selected case studies made it impossible to provide a simple rule for estimating the required ventilation rates. Consequently, we conclude that to design rooms with a low infection risk the newly developed ventilation design method must be used. •New design method for respiratory infection risk-based ventilation rates•Provides the required ventilation rate at a given probability and quanta emission•Estimates a low-risk ventilation rate from the event reproduction number•Case studies show ventilation rates starting from about 80 L/s per room•Is proposed for ventilation standards to complement existing ventilation criteria

Waste-to-energy (WtE) processes, or the combustion of refuse-derived fuel (RDF) for energy generation, has the potential to reduce landfill volume while providing a renewable energy source. We aimed to systematically review and summarise current evidence on the potential health effects (benefits and risks) of exposure to WtE/RDF-related combustion emissions. We searched PubMed and Google Scholar using terms related to health and WtE/RDF combustion emissions, following PRISMA guidelines. Two authors independently screened titles, abstracts and then full-texts of original, peer-reviewed research articles published until 20th March 2020, plus their relevant references. Overall quality of included epidemiological studies were rated using an amended Navigation framework. We found 19 articles from 269 search results that met our inclusion criteria, including two epidemiological studies, five environmental monitoring studies, seven health impact or risk assessments (HIA/HRA), and five life-cycle assessments. We found a dearth of health studies related to the impacts of exposure to WtE emissions. The limited evidence suggests that well-designed and operated WtE facilities using sorted feedstock (RDF) are critical to reduce potential adverse health (cancer and non-cancer) impacts, due to lower hazardous combustion-related emissions, compared to landfill or unsorted incineration. Poorly fed WtE facilities may emit concentrated toxins with serious potential health risks, such as dioxins/furans and heavy metals; these toxins may remain problematic in bottom ash as a combustion by-product. Most modelling studies estimate that electricity (per unit) generated from WtE generally emits less health-relevant air pollutants (also less greenhouse gases) than from combustion of fossil fuels (e.g. coal). Some modelled estimates vary due to model sensitivity for type of waste processed, model inputs used, and facility operational conditions. We conclude that rigorous assessment (e.g. HRA including sensitivity analyses) of WtE facility/technological characteristics and refuse type used is necessary when planning/proposing facilities to protect human health as the technology is adopted worldwide.

• Airborne transmission is a pathway of contagion of an epidemic. • Simulating the virus airborne transmission requires viral emission data. • A novel approach estimating the quanta emission rate of SARS-CoV-2 infected subject. • The approach estimates the quanta emission rate from the viral load in sputum. • Vocalization during light activity can lead to quanta emission rate >100 quanta h −1. Airborne transmission is a pathway of contagion that is still not sufficiently investigated despite the evidence in the scientific literature of the role it can play in the context of an epidemic. While the medical research area dedicates efforts to find cures and remedies to counteract the effects of a virus, the engineering area is involved in providing risk assessments in indoor environments by simulating the airborne transmission of the virus during an epidemic. To this end, virus air emission data are needed. Unfortunately, this information is usually available only after the outbreak, based on specific reverse engineering cases. In this work, a novel approach to estimate the viral load emitted by a contagious subject on the basis of the viral load in the mouth, the type of respiratory activity (e.g. breathing, speaking, whispering), respiratory physiological parameters (e.g. inhalation rate), and activity level (e.g. resting, standing, light exercise) is proposed. The results showed that high quanta emission rates (>100 quanta h −1 ) can be reached by an asymptomatic infectious SARS-CoV-2 subject performing vocalization during light activities (i.e. walking slowly) whereas a symptomatic SARS-CoV-2 subject in resting conditions mostly has a low quanta emission rate (

Evidence suggests that residential greenness may be protective of high blood pressure, but there is scarcity of evidence on the associations between greenness around schools and blood pressure among children. We aimed to investigate this association in China. Our study included 9354 children from 62 schools in the Seven Northeastern Cities Study. Greenness around each child's school was measured by NDVI (Normalized Difference Vegetation Index) and SAVI (Soil-Adjusted Vegetation Index). Particulate matter

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

The aim of the UN Sustainable Development Goals (SDGs) is to achieve a better and more sustainable future for all by 2030. Since the majority of the global population lives in cities, it is crucial to identify, evaluate and implement urban interventions (such as zero carbon housing, active transport, better urban connectivity, air pollution control, clean household fuels, and protection fromheat and flood events) that will improve health andwellbeing and make our natural and built environment more sustainable. This Virtual Special Issue (VSI) comprises of 14 diverse case studies, methods and tools that provide suggestions for interventions which directly or indirectly support the achievement of the UN SDGs. (c) 2020 Published by Elsevier B.V.

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65.4% decrease, 61.5-68.5) and in mortality rate (from 362.7 deaths [3304-392.0] per 100 000 children to 118.9 deaths [109.8-128.3] per 100 000 children; 67.2% decrease, 63.5-70.1). LRI incidence dedined globally (32.4% decrease, 27.2-37.5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11.4% decrease, 0.0-24.5), increased pneumococcal vaccine coverage (6.3% decrease, 6.1-6.3), and reductions in household air pollution (8.4%, 6 8-9.2). Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

The new particle formation due to the use of cleaning products containing volatile organic compounds (VOCs) in indoor environments is well documented in the scientific literature. Indeed, the physical‐chemical process occurring in particle nucleation due to VOC‐ozone reactions was deepened as well as the effect of the main influencing parameters (ie, temperature, ozone). Nonetheless, proper quantification of the emission under actual meteo‐climatic conditions and ozone concentrations is not available. To this end, in the present paper the emission factors of newly generated ultrafine particles due to the use of different floor cleaning products under actual temperature and relative humidity conditions and ozone concentrations typical of the summer periods were evaluated. Tests in a chamber and in an actual indoor environment were performed measuring continuously particle number concentrations and size distributions during cleaning activities. The tests revealed that a significant particle emission in the nucleation mode was present for half of the products under investigation with emission factors up to 1.1 × 1011 part./m2 (8.8 × 1010 part./mLproduct), then leading to an overall particle emission comparable to other well‐known indoor sources when cleaning wide surfaces.

Because of ethical and practical constraints, there are few experimental studies on the deposition of ultrafine particles (

Background Although the burden of influenza is often discussed in the context of historical pandemics and the threat of future pandemics, every year a substantial burden of lower respiratory tract infections (LRTIs) and other respiratory conditions (like chronic obstructive pulmonary disease) are attributable to seasonal influenza. The Global Burden of Disease Study (GBD) 2017 is a systematic scientific effort to quantify the health loss associated with a comprehensive set of diseases and disabilities. In this Article, we focus on LRTIs that can be attributed to influenza. Methods We modelled the LRTI incidence, hospitalisations, and mortality attributable to influenza for every country and selected subnational locations by age and year from 1990 to 2017 as part of GBD 2017. We used a counterfactual approach that first estimated the LRTI incidence, hospitalisations, and mortality and then attributed a fraction of those outcomes to influenza. Findings Influenza LRTI was responsible for an estimated 145 000 (95% uncertainty interval [UI] 99 000-200 000) deaths among all ages in 2017. The influenza LRTI mortality rate was highest among adults older than 70 years (16.4 deaths per 100 000 [95% UI 11.6-21.9]), and the highest rate among all ages was in eastern Europe (5.2 per 100 000 population [95% UI 3.5-7.2]). We estimated that influenza LRTIs accounted for 9 459 000 (95% UI 3 709 000-22 935 000) hospitalisations due to LRTIs and 81 536 000 hospital days (24 330 000-259 851 000). We estimated that 11.5% (95% UI 10.0-12.9) of LRTI episodes were attributable to influenza, corresponding to 54 481 000 (38 465 000-73 864 000) episodes and 8 172 000 severe episodes (5 000 000-13 296 000). Interpretation This comprehensive assessment of the burden of influenza LRTIs shows the substantial annual effect of influenza on global health. Although preparedness planning will be important for potential pandemics, health loss due to seasonal influenza LRTIs should not be overlooked, and vaccine use should be considered. Efforts to improve influenza prevention measures are needed. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd.

Hand washing and maintaining social distance are the main measures recommended by the World Health Organization (WHO) to avoid contracting COVID-19. Unfortunately, these measured do not prevent infection by inhalation of small droplets exhaled by an infected person that can travel distance of meters or tens of meters in the air and carry their viral content. Science explains the mechanisms of such transport and there is evidence that this is a significant route of infection in indoor environments. Despite this, no countries or authorities consider airborne spread of COVID-19 in their regulations to prevent infections transmission indoors. It is therefore extremely important, that the national authorities acknowledge the reality that the virus spreads through air, and recommend that adequate control measures be implemented to prevent further spread of the SARS-CoV-2 virus, in particularly removal of the virus-laden droplets from indoor air by ventilation.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

During the 2020 COVID-19 pandemic, an outbreak occurred following attendance of a symptomatic index case at a weekly rehearsal on 10 March of the Skagit Valley Chorale (SVC). After that rehearsal, 53 members of the SVC among 61 in attendance were confirmed or strongly suspected to have contracted COVID-19 and two died. Transmission by the aerosol route is likely; it appears unlikely that either fomite or ballistic droplet transmission could explain a substantial fraction of the cases. It is vital to identify features of cases such as this to better understand the factors that promote superspreading events. Based on a conditional assumption that transmission during this outbreak was dominated by inhalation of respiratory aerosol generated by one index case, we use the available evidence to infer the emission rate of aerosol infectious quanta. We explore how the risk of infection would vary with several influential factors: ventilation rate, duration of event, and deposition onto surfaces. The results indicate a best-estimate emission rate of 970 +/- 390 quanta/h. Infection risk would be reduced by a factor of two by increasing the aerosol loss rate to 5 h(-1)and shortening the event duration from 2.5 to 1 h.

Shanghai, a metropolitan city in China, has suffered from severe air pollution, especially PM2.5, in the last few years. Up to now the contribution of local emission and regional transport to the formation of haze in Shanghai remains unclear. With an aim to characterize the mechanism of haze formation in Shanghai, the present paper attempted to provide an overview of a tethered balloon-based field campaign. According to the backward trajectories, the air mass traveling slowly from Jiangsu province accounted for the highest PM2.5 concentration (66 ± 20 μg/m3). Seventy vertical profiles of PM2.5, NO, NO2, SO2 and O3 within 1000 m were obtained, through which a comparison study on the characteristics of the vertical distributions of air pollutants on clean days and haze days was conducted. When altitude increased, clearly decreasing pattern of PM2.5, NO, and NO2 was observed during the field campaign. Due to the low atmospheric boundary layer, the diffusion of air pollutants was suppressed, which favored the formation of haze. The results of the generalized additive model revealed NO2 could the most significant factor influencing the vertical distribution of PM2.5 in both clean and haze days. This study provides new insight into the sources and vertical distribution of PM2.5, which could offer references for air pollution modeling. [Display omitted] •NO2 was the most significant factor influencing the vertical distribution of PM2.5.•Polluted air mass from neighboring provinces could influence the air in Shanghai.•Low ABL favored the accumulation of air pollutants in haze days.

According to the World Health Organization (WHO) air pollution in urban areas, mainly associated with inha- lation of gaseous pollutants and particulate matter emitted from motor vehicles, is responsible for one million deaths per year. Carbon monoxide (CO) from the incomplete combustion of fuel is known to bind with hemo- globin, decreasing the blood oxygen -delivery and inducing tissues hypoxia; being more pronounced under con- ditions of stress like physical activity. The present study demonstrates the usefulness of a compact CO sensor (Alphasense CO -B4) mounted on a bicycle to evaluate atmospheric levels of CO associated with urban micro - environments within a growing Australian city (Brisbane). Urban bike pathways show pronounced and signi ficant variations in air quality according to the surrounding microenvironment and the time of day. The inhaled dose in real time and the CO total dose over each trip were valuable for estimating the air quality of the route, and identifed how the health bene fits of riding a bicycle could be partially offset by poor air quality depending on where and when a cycle route is taken in the inner-city. Finally, environmental conditions, such as wind speed, were found to signi ficantly affected atmospheric CO concentrations, at least during the study period. The present work provides information regarding commuters' exposure to atmospheric pollutants, necessary for modifying the population's (including cyclists) perception of pollution in the urban environment, providing people with the opportunity to choose a healthier route.

The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.

IMPORTANCE Few studies have investigated the association between greenness and childhood attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE To evaluate the association between greenness surrounding schools or kindergartens and symptoms of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study was performed between April 2012 and January 2013 in 7 cities in northeastern China. This analysis included 59 754 children (aged 2-17 years) from 94 schools and kindergartens, who had resided in the study area for 2 years or longer. Data were analyzed from April 15, 2019, to October 10, 2019. EXPOSURES Greenness surrounding each child's school or kindergarten was estimated using 2 satellite image-derived vegetation indexes: the normalized difference vegetation index and the soil-adjusted vegetation index. MAIN OUTCOMES AND MEASURES Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) scales were used to measure ADHD symptoms (9 inattention symptoms and 9 hyperactivity-impulsivity symptoms). Parents or guardians rated the frequency of each of 18 ADHD symptoms during the preceding 6 months. Children with 6 or more symptoms of either inattention or hyperactivity-impulsivity were defined as having ADHD symptoms. Generalized linear mixed models were applied to estimate the association between greenness and ADHD symptoms. RESULTS The mean (SD) age of the 59 754 study participants was 10.3 (3.6) years, and 29 494 (49.4%) were girls. A total of 2566 participants (4.3%) had ADHD symptoms. Greenness levels differed substantially across schools and kindergartens. The normalized difference vegetation index within 500 m of a school or kindergarten ranged from -0.09 to 0.77. Greater greenness levels were associated with lower odds of ADHD symptoms. In covariate-adjusted models, a 0.1-unit increase in normalized difference vegetation index or soil-adjusted vegetation index within 500mof a school or kindergarten was significantly associated with lower odds of ADHD symptoms (odds ratios, 0.87 [95% CI, 0.83-0.91] and 0.80 [95% CI, 0.74-0.86], respectively; P < .001 for both). The associations were robust in a series of sensitivity analyses. CONCLUSIONS AND RELEVANCE These findings suggest that there may be a beneficial association between school-based greenness and ADHD symptoms in Chinese children. Future longitudinal and mechanistic studies are needed to confirm the findings of this cross-sectional analysis and further explore potential mechanisms of this association.

There are currently more than 400 cities that are subject to the urban heat island (UHI) effect, whose summer temperature can be over 15 degrees C above the human thermal comfort zone. As the scope of urbanization expands, more people will feel the influence of the UHI effect. Since cool coatings can serve as a mitigation measure against the UHI effect, this research proposes a method that can estimate its mitigation effect in any given region. The main idea of this method is to simulate the function of cool coatings via increasing the albedo values in the Weather Research and Forecasting (WRF) model. The main novelty of this method is that it incorporates detailed land categorization data to simulate realistic urban morphology for the purpose of improving model performance. To demonstrate the feasibility of the proposed method, the UHI mitigation effect of cool coatings was estimated in the city of Sydney during two consecutive sweltering days (7-8 January 2018) via the WRF model. The results showed that the proposed method fulfilled its purpose. To be specific, as the consequence of a 0.35 albedo increase in urban Sydney, the whole urban area will be subject to an average temperature decrease of 0.76 degrees C, while some regions will experience a temperature decrease as great as 5.71 degrees C during the hottest hour. However, this value for a given zone, such as the downtown coast area, was closely related to the local wind directions. The results also showed that the values of different urban canopy parameters could be treated as auxiliary information of WRF modeling results and used to identify the locations that suffered the most from the UHI effect. Therefore, the proposed method can help decision-makers and stakeholders to better analyze the UHI mitigation potential of cool coatings. Additionally, it indicates incorporating detailed land categorization data is an effective way of improving UHI numerical simulations. (C) 2020 Elsevier Ltd. All rights reserved.

Small aerosols at a given location in the atmosphere often originate in situ from new particle formation (NPF). However, they can also be produced and then transported from a distant location to the point of observation where they may continue to grow to larger sizes. This study was carried out in the subtropical urban environment of Brisbane, Australia, in order to assess the relative occurrence frequencies of NPF events and particle growth events with no NPF. We used a neutral cluster and air ion spectrometer (NAIS) to monitor particles and ions in the size range 2-42 nm on 485 days, and identified 236 NPF events on 213 days. The majority of these events (37 %) occurred during the daylight hours with just 10% at night. However, the NAIS also showed particle growth with no NPF on many nights (28 %). Using a scanning mobility particle sizer (SMPS), we showed that particle growth continued at larger sizes and occurred on 70% of nights, typically under high relative humidities. Most particles in the air, especially near coastal locations, contain hygroscopic salts such as sodium chloride that may exhibit deliquescence when the relative humidity exceeds about 75 %. The growth rates of particles at night often exceeded the rates observed during NPF events. Although most of these night time growth events were preceded by day time NPF events, the latter was not a prerequisite for growth. We conclude that particle growth in the atmosphere can be easily misidentified as NPF, especially when they are monitored by an instrument that cannot detect them at the very small sizes.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic . Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches , while maintaining proven prevention measures using a vaccines-plus approach that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

Marine trade has significantly expanded over the past decades aiding to the economic development of the maritime countries, yet, this has been associated with a considerable increase in pollution emission from shipping operation. This study aims at considering both sides of the spectrum at the same time, which is including both public and shipping business. Of the key significance would be to optimize the operation of the shipping industry, such that its impact on air pollution is minimized, without, however, significant escalation of its cost, and therefore to protect the whole seaborne trade. To do this, we considered the impacts of three control strategies, including the current emission control area (ECA) design, as well two additional ones. Thus the first scenario (DECA1) was based on the China's domestic emission control area (DECA), which was set up in 2016. The DECA1 scale was only 12 nautical miles, which was much smaller than the emission control areas in US or Europe. We defined the second scenario (DECA2), by stretching the zone to 200 nautical miles towards the ocean, modeling it on the ECA in North America. The third scenario (DECA3), on the other hand, expanded the 12 nautical miles control zone along the whole coastline. To investigate the impact of shipping emissions on air quality, a shipping emission calculation model and an air quality simulation model were used, and Pearl River Delta (PRD), China was chosen to serve as a case study. The study demonstrated that in 2013 marine shipping emissions contributed on average 0.33 and 0.60μg·m , respectively to the land SO and PM concentrations in the PRD, and that the concentrations were high along the coastline. The DECA1 policy could effectively reduce SO and PM concentrations in the port regions, and the average reduction in the land area were 9.54% and 2.7%, respectively. Compared with DECA1, DECA2 would not measurably improve the air quality, while DECA3 would effectively decrease the pollution in the entire coast area. Thus, instead of expanding emission control area far to the ocean, it is more effective to control emissions along the coastline to secure the best air quality and lower the health impacts. By doing this, 19 million dollars of fuel cost could be saved per year. The saved cost could help the ship owners to endure, considering the current low profits of the seaborne trade, and thus to protect the overall growth of the economy.

It is unknown whether giving birth via caesarean section (c-section) is a modifier for the association between air pollution and asthma. From 2012 to 2013, 59,754 children between the ages of 2 and 17 were randomly selected from 94 middle schools, elementary schools and kindergartens in seven Chinese cities for a cross-sectional study. The children's parents or guardians completed questionnaires, from which data on asthma as well as asthma-related symptoms were obtained. Participants' exposure to particles with an aerodynamic diameter

Australia is a highly developed country with low population density. Capital cities are situated mainly around the coastline and are subjected to different meteorological conditions. This complex set of drivers is expected to result in varying trends in particulate matter (PM) mass concentrations in urban ambient air across the country. Thus, the aim of this study was to determine the long-term trends in PM10 and PM2.5 concentrations in capital cities, and to analyse the factors that influenced such trends. The spatial variability of PM concentrations within the capital cities was first established to identify representative stations. Then trends were determined using the Mann-Kendall trend test, Sen's slope, and the generalised additive model. The results show that, in general, the PM concentrations in Australian cities are relatively low (12.1–21.7 μg m−3 mean daily PM10 and 4.6–8.7 μg m−3 mean daily PM2.5) and within the WHO daily limit 95% of the time. Over the past two decades, very small declines of 8.0 × 10−5–1.1 × 10−3 μg m−3.yr−1 for PM10 and 7.7 × 10−5–2.6 × 10−3 μg m−3.yr−1 for PM2.5 were observed while some stations exhibited increase in concentration based on available data; more stations showed a significant monotonic decline for PM10 than PM2.5. This is attributed to the effectiveness of the implemented emission reduction policies particularly for vehicle exhaust and power generation, given the simultaneous increase in the demand for energy and the number of vehicles over the last two decades. Regarding climate, in the coastal cities of Sydney and Brisbane, high rainfall and strong winds aid in maintaining low PM concentrations despite the significant anthropogenic emissions, while higher PM levels in Darwin can be attributed to its tropical savannah climate, which makes it prone to bushfires and necessitates regular prescribed burnings. PM concentrations increase when exceptional events such as bushfires and dust storms are induced by the extreme climate variability. Further reduction of PM concentrations in Australian cities is unlikely, considering the expanding urbanisation and the changing climate. •A very small decline of already low PM10 and PM2.5 occurred over two decades.•Regulations were effective in controlling concentrations despite urbanization.•Climate change induced bushfires and dust storms increase PM concentrations.•Further improvement in current PM concentrations of Australian cities is unlikely.

•Long-term PM1 and PM2.5 exposure can lead to decreased lung function in children.•Association of PM1 with children's lung function are larger than PM2.5.•PM1 and PM2.5 are associated with children’s large/small airways in early/late life. Experimental data suggests that PM1 is more toxic than PM2.5 although the epidemiologic evidence suggests that the health associations are similar. However, few objective exposure data are available to compare the associations of PM1 and PM2.5 with children lung function. Our objectives are a) to evaluate associations between long-term exposure to PM1, PM2.5 and children’s lung function, and b) to compare the associations between PM1 and PM2.5. From 2012 to 2013, we enrolled 6,740 children (7–14 years), randomly recruited from primary and middle schools located in seven cities in northeast China. We measured lung function including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) utilizing two portable electronic spirometers. We dichotomized continuous lung function measures according the expected values for gender and age. The spatial resolution at which PM1 and PM2.5 estimated were estimated using a machine learning method and the temporal average concentrations were averaged from 2009 to 2012. A multilevel regression model was used to estimate the associations of PM1, PM2.5 exposure and lung function measures, adjusted for confounding factors. Associations with lower lung function were consistently larger for PM1 than for PM2.5. Adjusted odds ratios (OR) per interquartile range greater PM1 ranged from 1.53 for MMEF (95% confidence interval [CI]: 1.20–1.96) to 2.14 for FEV1 (95% CI: 1.66–2.76) and ORs for PM2.5 ranged from 1.36 for MMEF (95%CI: 1.12–1.66) to 1.82 for FEV1 (95%CI: 1.49–2.22), respectively. PM1 and PM2.5 had significant associations with FVC and FEV1 in primary school children, and on PEF and MMEF in middle school children. Long-term PM1 and PM2.5 exposure can lead to decreased lung function in children, and the associations of PM1 are stronger than PM2.5. Therefore, PM1 may be more hazardous to children’s respiratory health than PM2.5 exposure.

Can mitigating only particle mass, as the existing air quality measures do, ultimately lead to reduction in ultrafine particles (UFP)? The aim of this study was to provide a broader urban perspective on the relationship between UFP, measured in terms of particle number concentration (PNC) and PM2.5 (mass concentration of particles with aerodynamic diameter 1 for roadside sites and

ObjectivesThis study quantified the secondhand smoke (SHS) concentration in a sample of public places in Vietnam to determine changes in SHS levels 5 years after a public smoking ban was implemented.MethodsTwo monitoring campaigns, one in 2013 (before the tobacco control law was implemented) and another in 2018 (5 years after the implementation of the law) were conducted in around 30 restaurants, cafeterias and coffee shops in major cities of Vietnam. Concentrations of PM2.5, as an indicator of SHS, were measured by portable particulate matter monitors (TSI SidePak AM510 and Air Visual Pro).ResultsThe geometric mean PM2.5 concentration of all monitored venues was 87.7 µg/m3 (83.7–91.9) in the first campaign and 55.2 µg/m3 (53.7–56.7) in the second campaign. Pairwise comparison showed the PM2.5 concentrations in the smoking observed area was triple and double those in the non-smoking area and the outdoor environment. After adjusting for sampling locations and times, the SHS concentration 5 years after the implementation of the tobacco control law reduced roughly 45%.ConclusionThe study results indicate an improvement in air quality in public places in Vietnam via both the reduction in PM2.5 levels and the number of people observed smoking. However, greater enforcement of the free-smoke legislation is needed to eliminate SHS in public places in Vietnam.

Background: The role of space suits in the prevention of orthopedic prosthetic joint infection remains unclear. Recent evidence suggests that space suits may in fact contribute to increased infection rates, with bioaerosol emissions from space suits identified as a potential cause. This study aimed to compare the particle and microbiological emission rates (PER and MER) of space suits and standard surgical clothing. Methods: A comparison of emission rates between space suits and standard surgical clothing was performed in a simulated surgical environment during 5 separate experiments. Particle counts were analyzed with 2 separate particle counters capable of detecting particles between 0.1 and 20 mm. An Andersen impactor was used to sample bacteria, with culture counts performed at 24 and 48 hours. Results: Four experiments consistently showed statistically significant increases in both PER and MER when space suits are used compared with standard surgical clothing. One experiment showed inconsistent results, with a trend toward increases in both PER and MER when space suits are used compared with standard surgical clothing. Conclusion: Space suits cause increased PER and MER compared with standard surgical clothing. This finding provides mechanistic evidence to support the increased prosthetic joint infection rates observed in clinical studies. (C) 2017 Elsevier Inc. All rights reserved.

Epidemiological studies investigating the association between daily particle exposure and health effects are frequently based on a single monitoring site located in an urban background. Using a central site in epidemiological time-series studies has been established based on the premises of low spatial variability of particles within the areas of interest and hence the adequacy of the central sites to monitor the exposure. This is true to a large extent in relation to larger particles (PM2.5, PM10) that are typically monitored and regulated. However, the distribution of ultrafine particles (UFP), which in cities predominantly originate from traffic, is heterogeneous. With increasing pressure to improve the epidemiology of UFP, an important question to ask is, whether central site monitoring is representative of community exposure to this size fraction of particulate matter; addressing this question is the aim of this paper. To achieve this aim, we measured personal exposure to UFP, expressed as particle number concentration (PNC), using Philips Aerasense Nanotracers (NT) carried by the participants of the study, and condensation particle counters (CPC) or scanning mobility particle sizers (SMPS) at central fixed-site monitoring stations. The measurements were conducted at three locations in Brisbane (Australia), Cassino (Italy) and Accra (Ghana). We then used paired t-tests to compare the average personal and average fixed-site PNC measured over the same 24-h, and hourly, periods. We found that, at all three locations, the 24-h average fixed-site PNC was no different to the personal PNC, when averaged over the study period and all the participants. However, the corresponding hourly averages were significantly different at certain times of the day. These were generally times spent commuting and during cooking and eating at home. Our analysis of the data obtained in Brisbane, showed that maximum personal exposure occurred in the home microenvironment during morning breakfast and evening dinner time. The main source of PNC for personal exposure was from the home-microenvironment. We conclude that the 24-h average PNC from the central-site can be used to estimate the 24-h average personal exposure for a community. However, the hourly average PNC from the central site cannot consistently be used to estimate hourly average personal exposure, mainly because they are affected by very different sources. [Display omitted] •Particle number concentrations were monitored in three widely separated cities.•Data from personal sampling and fixed station measurements were compared.•Agreement was good over long averaging periods such as 24 h.•Agreement was poor over short periods such as hourly.•Reasons for the differences are presented and discussed.

Exposure to air pollutants, including black carbon (BC), during transportation is an important contribution to the total daily respiratory exposure for humans. Exposure to BC is especially relevant in crowded cities of developing countries. Specifically, in Hanoi (Vietnam), air pollution including BC is of concern, particularly near traffic. Despite public interest, no studies have been undertaken to understand the levels of respiratory exposure of BC to commuters in Hanoi, who predominantly use motorcyles. In this study, we simultaneously measured BC concentrations using microAeth AE51 portable devices on motorcycles, and in the cabins of cars and buses. The mean BC concentration on motorcycles was 29.4 μg/m3 compared to 10.1 μg/m3 in the buses. BC concentrations were also shown to be influenced by traffic density. Measurements during peak traffic showed BC concentrations of 34.7 μg/m3 and 12.1 μg/m3 for motorcyclists and bus passengers, respectively. For non-rush hour periods (on weekdays), the corresponding BC levels were 27.7 and 8.4 μg/m3, respectively. BC levels inside of a passenger car with different ventilation modes was also examined. The concentrations of BC inside the cabin of a passenger car were 18.1 μg/m3 and 11.7 μg/m3, with the windows open and closed, respectively. It is estimated that motorcyclists are exposed to a significantly higher level of BC than users of buses and cars. Our findings are evidence for promoting the use of public transportation to protect public health in Hanoi, which may also be applicable to other cities in South-East Asia with similar traffic characteristics. [Display omitted] •Respiratory BC exposure was monitored in different transport microenvironments.•Mean BC concentrations were highest on motorcycles, followed by cars and buses.•Exposure to BC during commuting is also affected by traffic density.•Commuters can reduce exposure to BC by using buses instead of motorcycles.

New particle formation (NPF) is a common occurrence in urban environments where it is promoted by a ready supply of gaseous precursors such as sulfuric acid, ammonium and volatile organic compounds originating mainly from motor vehicle emissions, In this paper, we investigate the influence of wind speed on the occurrence of NPF events in a subtropical urban environment. The analysis was based on a large data set obtained with a neutral cluster and air ion spectrometer (NAIS) over 485 days of observations, out of which NPF events were observed on 213 days. Particles formation was most likely to occur during the morning hours and we observed NPF events between 8 am and noon on 123 of these days. In order to assess its influence, we estimated the mean wind speed between 8 and 9 am on these 123 days and on the days with no NPF. We found a statistically significant difference in average wind speeds during days with NPF (1.31 m s(-1)) and days with no NPF (1.84 m s(-1)) (p < 0.05). Several studies have shown that increasing wind speed enhances NPF in polluted megacities by removing pre-existing particles. Our observations indicate that this effect is less important in smaller cities, so that higher wind speeds can mitigate NPF by the removal of condensable gases. The wind speed does not affect the rate of NPF in clean environments.

Australia commonly experiences extensive wildfires, mostly during its hot dry summers. These often lead to a significant loss of life and property. The October 2013 Blue Mountains Fire burnt through more than 100,000 hectares and generated a large amount of fire dust that was transported to the downwind community residing in the Sydney metropolitan area, which is the largest city in Australia. Record-breaking temperatures in New South Wales and strong winds worsened the wildfire danger index, and the extensive fires that broke out by 17th October lasted for more than a week. Analysis of the particulate matter monitored by the New South Wales Environmental Protection Authority around the fire zone showed that the concentrations of PK10 and PM2.5 increased by more than twofold (> 200%) and remained high for a week. During the peak fire period, SOx, NOx, and O-3 concentrations increased by 52%, 29% and 42%, respectively, above the usual levels recorded in metropolitan Sydney. The increase in the concentrations of these air contaminants in the Sydney metropolitan region over such an extended period may have caused increased human health risks, which are also examined in this paper.

Epidemiological studies on the impact of outdoor temperature to human health have demonstrated the capability of humans to adapt to local climate. However, there is limited information on the association between indoor temperature and human health, despite people spending most of their time indoors. The problem stems from the lack of sufficient indoor temperature measurement in the population. To overcome this obstacle, this paper presents an indirect epidemiological approach to evaluate the impact of high indoor temperature on mortality. The relationships between indoor-outdoor temperatures in different climate zones identified in the literature were combined with the outdoor temperature mortality curves of the same locations to obtain the local indoor minimum mortality temperatures (iMMT), the temperature at which mortality is lowest, which by implication is the temperature at which the population is most comfortable on average. We show that the iMMT varies and has a weak linear relationship with the distance to the equator, which provides evidence of human adaptation to local indoor temperatures. These findings reinforce the adaptive comfort theory, which states that people can adapt to local indoor environment and establish their thermal comfort. Recognising the human adaptability to local climate will direct flexible and optimized policy to protect public health against extreme temperature events. This will also help reduce energy consumption for regulating indoor temperature without compromising the occupants' health. (C) 2018 Elsevier Ltd. All rights reserved.

BackgroundPast research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.MethodsWe reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).FindingsIn 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).InterpretationInjuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.

•Respiratory tract deposition of UFPs was measured first time for children at school.•Inhaled UFPs were categorized into groups of traffic exhaust and urban background..•Traffic-related UFPs showed higher total deposition fraction than urban background’s. A critical element of the risk assessment of exposure to airborne ambient ultrafine particles (UFP) is the quantification of respiratory tract deposition (RTD) of the particles, which is intrinsically challenging, particularly at the population scale. In this study, we used a recently proposed method to experimentally determine the RTD of urban UFP in a large group of children exposed to these particles in a school setting in Brisbane, Australia. Children are one of the most susceptible population groups; However, little is known about the deposition of UFP from urban traffic in their airways. In order to advance the knowledge in this field, the objectives of this study were: to determine the deposition of ambient urbane UFP in large number children, to catergorize the source of inhaled UFPs and hence to assess the contribution of air pollution sources to the deposition. RTD was measured in children aged 8–11 at primary schools using a flow-through chamber bag system. First, the inhaled and exhaled air was separated; then the particle number size distribution and particle number concentration were measured. The sources of inhaled UFP were categorized according to their particle number size distribution by a K means cluster technique. A total of 128 children from five schools performed the RTD measurement. The mean total deposition fraction of urban UFP in all children was 0.59 ± 0.10. Inhaled UFP were categorized into two groups: traffic and urban background, with the GMD of corresponding particle number size distribution of 20 nm and 40 nm, respectively. The total deposition fraction (mean ± SD) of UFP from these two groups was 0.68 ± 0.09 for traffic and 0.55 ± 0.08 for urban background respectively. This is the first study in which RTD was measured in a large group of children inhaling real urban UFP. First, we proved that this novel method can indeed be applied easily and quickly to a large group of people. Second, we quantified the RTD of children, thus providing an important input to the risk assessment for exposure to UFP.

In the present study, the daily dose in terms of particle surface area received by citizens living in different low- and middle-income countries, characterized by different lifestyles, habits, and climates, was evaluated. The level of exposure to submicron particles and the dose received by the populations of Accra (Ghana), Cairo (Egypt), Florianopolis (Brazil), and Nur-Sultan (Kazakhstan) were analyzed. A direct exposure assessment approach was adopted to measure the submicron particle concentration levels of volunteers at a personal scale during their daily activities. Non-smoking adult volunteers performing non-industrial jobs were considered. Exposure data were combined with time-activity pattern data (characteristic of each population) and the inhalation rates to estimate the daily dose in terms of particle surface area. The received dose of the populations under investigation varied from 450 mm(2) (Florianopolis, Brazil) to 1300 mm(2) (Cairo, Egypt). This work highlights the different contributions of the microenvironments to the daily dose with respect to high-income western populations. It was evident that the contribution of the Cooking & Eating microenvironment to the total exposure (which was previously proven to be one of the main exposure routes for western populations) was only 8%-14% for low- and middle-income populations. In contrast, significant contributions were estimated for Outdoor day and Transport microenvironments (up to 20% for Cairo, Egypt) and the Sleeping & Resting microenvironment (up to 28% for Accra, Ghana), highlighting the effects of different site-specific lifestyles (e.g. time-activity patterns), habits, socioeconomic conditions, climates, and outdoor air quality. (C) 2020 Elsevier Ltd. All rights reserved.

The industrial combustion of biomass, which has always been considered a source of clean and sustainable energy, might be phased out in China because it is believed to cause extremely high emissions of volatile organic compounds (VOCs), which are the key precursors in the formation of ozone and haze, although the emission factors have rarely been measured. In this study, the emissions of VOCs and several other air pollutants from typical industrial bagasse-fired boilers were measured for the first time. It was found that the emission factor (EF) of VOCs was 0.108 ± 0.034 g kg−1 (or 5.31 ± 1.68 g GJ−1 on an energy basis), which was roughly one order of magnitude lower than the officially recommended EF for industrial biomass combustion in China. In addition, the emissions of SO2, NOx and Hg from bagasse-fired boilers were even lower than those stipulated in the regulations for gas-fired boilers, with the exception of the particulate matter (PM), which was much lower than that produced during the open burning of biomass but higher than that from solid-fuel-fired boilers, likely as a result of the application of an ineffective dust removal device. It was demonstrated that the industrial combustion of biomass might produce much lower VOC emissions than expected and could help alleviate air pollution if biomass (at least bagasse) were used on a large scale instead of simply being burned in the field. In the future, dust removal devices with high efficiency should compulsorily be applied to industrial biomass boilers, and additional types of biomass fuel should be thoroughly evaluated to provide air-quality and energy policy makers with important insights. [Display omitted] •VOC source profiles from bagasse-fired boilers were measured for the first time.•VOC emissions from biomass boilers may have been substantially overestimated.•The emissions of SO2, NOx, and Hg from bagasse-fired boilers were very low.•Industrial biomass combustion could alleviate the air pollution caused by open burning.

In everyday life, people are exposed to different concentrations of airborne particles depending on the microenvironment where they perform their different activities. Such exposure can lead to high sub micron particle doses. The received dose depends on particle concentration to which people are exposed (typically expressed in terms of number or surface area), time spent in each activity or microenvironment (time activity pattern) and amount of air inhaled (inhalation rate). To estimate an actual value of the received dose, all these parameters should be measured under real-life conditions; in fact, the concentrations should be measured on a personal scale (i.e. through a direct exposure assessment), whereas time activity patterns and inhalation rates specific to the activity performed should be considered. The difficulties in obtaining direct measurements of these parameters usually lead to adopt time activity patterns and inhalation rates already available in scientific literature for typical populations, and local outdoor particle concentrations measured with fixed monitoring stations and extrapolated for all the other microenvironments. To overcome these limitations, we propose a full-field method for estimating the received dose of a population sample, in which all the parameters (concentration levels, time activity patterns and inhalation rates) are measured under real-life conditions (also including the inhalation rates, that were evaluated on the basis of the measured heart rates). Specifically, 34 volunteers were continuously monitored for seven days and the data of sub-micron particle concentrations, activities performed, and inhalation rates were recorded. The received dose was calculated with the proposed method and compared with those obtained from different simplified methodologies that consider typical data of particle concentrations, time activity patterns and inhalation rates obtained from literature. The results show that, depending on the methodology used, the differences in the received daily dose can be significant, with a general underestimation of the most simplified method. (C) 2020 Elsevier Ltd. All rights reserved.

Background Effective vaccines are now available for SARS-CoV-2 in the 2nd year of the COVID-19 pandemic, but there remains significant uncertainty surrounding the necessary vaccination rate to safely lift occupancy controls in public buildings and return to pre-pandemic norms. The aim of this paper is to estimate setting-specific vaccination thresholds for SARS-CoV-2 to prevent sustained community transmission using classical principles of airborne contagion modeling. We calculated the airborne infection risk in three settings, a classroom, prison cell block, and restaurant, at typical ventilation rates, and then the expected number of infections resulting from this risk at varying percentages of occupant immunity. Results We estimate the setting-specific immunity threshold for control of wild-type SARS-CoV-2 to range from a low of 40% for a mechanically ventilation classroom to a high of 85% for a naturally ventilated restaurant. Conclusions If vaccination rates are limited to a theoretical minimum of approximately two-thirds of the population, enhanced ventilation above minimum standards for acceptable air quality is needed to reduce the frequency and severity of SARS-CoV-2 superspreading events in high-risk indoor environments.

Reducing the transmission of SARS-CoV-2 through indoor air is the key challenge of the COVID-19 pandemic. Crowded indoor environments, such as schools, represent possible hotspots for virus transmission since the basic non-pharmaceutical mitigation measures applied so far (e.g. social distancing) do not eliminate the airborne transmission mode. There is widespread consensus that improved ventilation is needed to minimize the transmission potential of airborne viruses in schools, whether through mechanical systems or ad-hoc manual airing procedures in naturally ventilated buildings. However, there remains significant uncertainty surrounding exactly what ventilation rates are required, and how to best achieve these targets with limited time and resources. This paper uses a mass balance approach to quantify the ability of both mechanical ventilation and ad-hoc airing procedures to mitigate airborne transmission risk in the classroom environment. For naturally-ventilated classrooms, we propose a novel feedback control strategy using CO2 concentrations to continuously monitor and adjust the airing procedure. Our case studies show how such procedures can be applied in the real world to support the reopening of schools during the pandemic. Our results also show the inadequacy of relying on absolute CO2 concentration thresholds as the sole indicator of airborne transmission risk.

Particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) concentrations vary between countries with similar carbon dioxide (CO2) emissions, which can be partially explained by differences in air pollution control efficacy. However, no indicator of air pollution control efficacy has yet been developed. We aimed to develop such an indicator, and to evaluate its global and temporal distribution and its association with country-level health metrics. A novel indicator, ambient population-weighted average PM2.5 concentration per unit per capita CO2 emission (PM2.5/CO2), was developed to assess country-specific air pollution control efficacy (abbreviated as APCI). We estimated and mapped the global average distribution of APCI and its changes during 2000–2016 across 196 countries. Pearson correlation coefficients and Generalized Additive Mixed Model (GAMM) were used to evaluate the relationship between APCI and health metrics. APCI varied by country with an inverse association with economic development. APCI showed an almost stable trend globally from 2000 to 2016, with the low-income groups increased and several countries (China, India, Bangladesh) decreased. The Pearson correlation coefficients between APCI and life expectancy at birth (LE), infant-mortality rate (IMR), under-five year of age mortality rate (U5MR) and logarithm of per capita GDP (LPGDP) were −0.57, 0.65, 0.66, −0.59 respectively (all P values 

COVID-19 has demonstrated the devastating consequences of the rapid spread of an airborne virus in residential aged care. We report the use of CO2-based ventilation assessment to empirically identify potential 'super-spreader' zones within an aged care facility, and determine the efficacy of rapidly implemented, inexpensive, risk reduction measures.

•Information relating to personal UFP exposure in Ghana is lacking.•We assessed the daily personal UFP exposure of schoolchildren in and near Accra.•Exposure to UFPs in Accra was among the highest in the world.•Emissions from cooking, combustion and traffic were the main sources of UFPs. Exposure to air pollution is a significant health risk, and children who are exposed to it are likely to have lifelong consequences. Ultrafine particles (UFPs) are emitted by all combustion sources, and can be used as a proxy for the presence of combustion products. The present study, the first of its kind to be conducted in Africa, assessed schoolchildren’s exposure to UFPs, and apportioned their daily exposure to seven different microenvironments that they inhabited on a typical school day. The personal exposure of 61 pupils attending three junior high schools was measured for 24 h each using wearable monitors over a period of 10 weeks. Two of the schools were located in suburbs of Accra and the third in Berekuso, a nearby rural community. The results of our study revealed the complex nature of children’s UFP exposure and its overall high to very high levels, significantly influenced by the locality (suburb) of residence and the type of activities in which the children were engaged. The mean (±standard error) daily exposure to UFPs (cm-3) was6.9×104(±6.8×103),4.9(±1.0)×104 and 1.6×104±1.9×103for pupils attending the Ashia Mills, Faith Baptist and Berekuso Basic Schools, respectively. Pupils attending the schools in urban Accra received higher exposure than those attending the school in the rural environment of Berekuso. The highest mean microenvironmental exposure was registered in the Home other microenvironment in an urban school and in Bedroom in another urban school and the rural school. The high exposure in Home other was due to pupils conducting trash burning and encountering environmental tobacco smoke, and the high exposure in Bedroom microenvironment was due to the burning of mosquito coils at night to prevent malaria. The principal sources that heightened exposure to UFPs were emissions from cooking (using firewood and charcoal), vehicular traffic and combustion of biomass and trash. All pupils recorded the highest exposure intensity in the Kitchen microenvironment.

In environmental monitoring, the ability to obtain high-quality data across space and time is often limited by the cost of purchasing, deploying and maintaining a large collection of equipment, and the employment of personnel to perform these tasks. An ideal design for a monitoring campaign would be dense enough in time to capture short-range variation at each site, long enough in time to examine trends at each site and across all sites, and dense enough in space to allow modelling of the relationship between the means at each of the sites. This paper outlines a methodology for semiparametric spatiotemporal modelling of data that is dense in time but sparse in space, obtained from a split panel design, the most feasible approach to covering space and time with limited equipment. The data are hourly averaged particle number concentration (PNC) and were collected as part of the International Laboratory for Air Quality and Health's Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) project. The panel design comprises two weeks of continuous measurements taken at each of a number of government primary schools in the Brisbane Metropolitan Area, with each school visited sequentially. The school data are augmented by data from long-term monitoring stations at three locations in Brisbane, Australia. The temporal part of the model explains daily and weekly cycles in PNC at the schools. The temporal variation is modelled hierarchically with a penalised random walk term common to all sites and a similar term accounting for the remaining temporal trend at each site. The modelling of temporal trends requires an acknowledgement that the observations are correlated rather than independent. At each school and long-term monitoring site, peaks in PNC can be attributed to the morning and afternoon rush hour traffic and new particle formation events. The spatial component of the model describes the school-to-school variation in mean PNC at each school and within each school ground. The spatial term in the model is derived from a stochastic partial differential equation and approximates a Gaussian process with a Gaussian Markov Random field. Fitting the model helps describe spatial and temporal variability at a subset of the UPTECH schools and the long-term monitoring sites, which can be used to estimate the exposure of school children to ultrafine particles. Parameter estimates and their uncertainty are computed in a computationally efficient approximate Bayesian inference environment, R-INLA.

Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings In 2016, there were 5.5 million (95% UI 5.3 to 5.7) deaths and 116.4 million (111.4 to 121.4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36.2% (-39.3 to -33.6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34.2% (-37.2 to -31.5), also with decreases in all SDI quintiles. There were 13.7 million (12.7 to 14.7) new stroke cases in 2016. Global age-standardised incidence declined by 8.1% (-10.7 to -5.5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80.1 million (74.1 to 86.3) prevalent cases of stroke globally in 2016; 41.1 million (38.0 to 44.3) in women and 39.0 million (36.1 to 42.1) in men. Interpretation Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

The aim of this study was to assess the impact of ventilation and filtration conditions on particle concentrations in an orthopedic operating room. Total particle, viable particle, and CO2 concentration were measured under three different situations, namely before air filter replacement, after air filter replacement, and in an operating room with a new air conditioning system. Before air filter replacement, the mean values of airflow, total particle concentration, and viable particle concentration were 706 m(3)/h, 15.0 x 10(6) +/- 4.0 x 10(6) particles/m(3), and 57 CFU/m(3), respectively. After replacement, the airflow increased to 1954 m(3)/h, and total and viable particle concentrations decreased to 0.4 x 10(6) +/- 0.2 x 10(6) particles/m(3) and 24 CFU/m(3), respectively. In the room with a new air conditioning system, the airflow was 2051 m(3)/h, and total and viable particle concentrations were 0.3 x 10(6.) +/- 0.1 x 10(6) particles/m(3) and 15 CFU/m(3), respectively. The CO2 levels were 663 ppm (before), 659 ppm (after), and 574 ppm (new room). The results showed that inappropriate or no maintenance of filters in an air conditioning system had significant negative effects on indoor air quality in operating rooms. Air conditioning systems operating with saturated filters can be affected by pressure drop, which can lead to a reduction in airflow, thereby resulting in an increase in the average total particle and viable particle concentrations and the risk of infection in operating rooms. However, the results showed that the CO2 concentration was not affected by the filter replacement.

Urbanisation and industrialisation led to the increase of ambient particulate matter (PM) concentration. While subsequent regulations may have resulted in the decrease of some PM matrices, the simultaneous changes in climate affecting local meteorological conditions could also have played a role. To gain an insight into this complex matter, this study investigated the long-term trends of two important matrices, the particle mass (PM2.5) and particle number concentrations (PNC), and the factors that influenced the trends. Mann-Kendall test, Sen’s slope estimator, the generalised additive model, seasonal decomposition of time series by LOESS (locally estimated scatterplot smoothing) and the Buishand range test were applied. Both PM2.5 and PNC showed significant negative monotonic trends (0.03–0.6 μg m−3. yr−1 and 0.40–3.8 × 103 particles. cm−3. yr−1, respectively) except Brisbane (+0.1 μg m−3. yr−1 and +53 particles. cm−3. yr−1, respectively). For the period covered in this study, temperature increased (0.03–0.07 °C.yr−1) in all cities except London; precipitation decreased (0.02–1.4 mm. yr−1) except in Helsinki; and wind speed was reduced in Brisbane and Rochester but increased in Helsinki, London and Augsburg. At the change-points, temperature increase in cold cities influenced PNC while shifts in precipitation and wind speed affected PM2.5. Based on the LOESS trend, extreme events such as dust storms and wildfires resulting from changing climates caused a positive step-change in concentrations, particularly for PM2.5. In contrast, among the mitigation measures, controlling sulphur in fuels caused a negative step-change, especially for PNC. Policies regarding traffic and fleet management (e.g. low emission zones) that were implemented only in certain areas or in a progressive uptake (e.g. Euro emission standards), resulted to gradual reductions in concentrations. Therefore, as this study has clearly shown that PM2.5 and PNC were influenced differently by the impacts of the changing climate and by the mitigation measures, both metrics must be considered in urban air quality management. [Display omitted] •Both PM2.5 and PNC had a monotonic downward trend in all cities except Brisbane.•Extreme events due to changing climates caused positive step-changes to PM2.5.•Negative step-changes in PNC were observed upon regulation of sulphur in fuels.•Gradual reduction of PM2.5 and PNC was achieved by traffic and fleet management.

As the environmental awareness of urban citizens increases, traditional air quality monitoring stations cannot satisfy the need for air quality data at high temporal and spatial resolution due to their high construction and maintenance costs. Low-cost air quality monitors are being increasingly used for this purpose because of their portability and affordable price. However, low-cost monitors are usually beset by data quality issues, and the number of mounted air pollutant sensors is limited by the restriction of the cost and size of monitors. Therefore, we propose to extend the use of air quality monitor data via a deep learning technique called long short-term memory (LSTM). The extension is embodied in two aspects: first, calibration of air pollutant concentration data; and second, provision of indicative information about air pollutants where no corresponding sensors are available. A low-cost air quality monitor called KOALA (Knowing Our Ambient Local Air Quality), which was deployed in Sydney (Australia), was used as an example to prove this method's feasibility. Data from a 90-day period were used for model training, and data from a 30-day period were used for model validation. Random forest models were used for selecting the most useful LSTM model input variables. Historical 24-h information was incorporated to improve the performance of the LSTM models. The results showed that: first, LSTM models can be used to calibrate KOALA carbon monoxide (CO) data with the optimum input being raw CO measurements and the corresponding standard deviation information; and second, LSTM models can be used to estimate ozone concentration with the optimum input being CO concentration and three meteorological parameters [i.e. top soil layer temperature, 10 m U wind (earth-relative), and net shortwave radiation flux at the ground] generated through a deterministic model known as WRF (Weather Research and Forecasting). In addition, the LSTM ozone estimation model showed good performance at both the training location and a location 11 km away, indicating that the proposed method can be used to provide indicative information about air pollutants around the training location. (c) 2020 Elsevier Ltd. All rights reserved.

BackgroundThe epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.MethodsInjury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm—the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.ResultsFor many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.ConclusionsThe overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Mobile phones have a large spectrum of applications, aiding in risk prevention and improving health and wellbeing of their owners. So far, however, they have not been used for direct assessment of personal exposure to air pollution. In this study, we comprehensively evaluated the first, and the only available, mobile phone-BROAD Life-equipped with air pollution sensors (PM2.5 and VOC), to answer the question whether this technology is a viable option in the quest of reducing the burden of disease to air pollution. We tested its performance, applicability and suitability for the purpose by subjecting it to varied concentrations of different types of aerosol particles (cigarette smoke, petrol exhaust and concrete dust) and formaldehyde under controlled laboratory conditions, as well as to ambient particles during field measurements. Six reference instruments were used in the study: AEROTRAK Optical Particle Counter (OPC model number 9306), DustTrak, Aerodynamic Particle Counter (APS), Scanning Mobility Particle Sizer (SMPS), Tapered Element Oscillating Microbalance (TEOM) and Formaldehyde Analyser. Overall, we found that the phone's response was linear at higher particle number concentrations in the chamber, above 5 and 10 mu g m(-3), for combustion and concrete dust particles, respectively, and for higher formaldehyde concentrations, making it potentially suitable for applications in polluted environments. At lower ambient concentrations of particles around 10 mu g m(-3) and 20 mu g m(-3) for PM2.5 and PM10, respectively, the phone's response was below its noise level, suggesting that it is not suitable for ambient monitoring under relatively clean urban conditions. This mobile phone has a number of limitations that may hinder its use in personal exposure and for continuous monitoring. Despite these limitations, it may be used for comparative assessments, for example when comparing outcomes of intervention measures or local impacts of air pollution sources. It should be kept in mind, however, that a mobile phone measuring air quality alone cannot as such 'reduce the burden of disease to air pollution, as knowing ambient concentrations is only one of the building block in this quest. As long as individuals cannot avoid exposure e.g. in urban areas, knowing concentrations is not sufficient to reduce potential adverse effects. Yet, there are many situations and microenvironments, which individuals could avoid knowing the concentrations and also being aware of the risk caused by exposure to them. This includes for example to proximity to vehicle emissions, either for social purposes (e.g. street cafes) or exercising (e.g. walking or jogging along busy roads) or indoor environments affected by combustion emissions ( smoking, candle burning, open fire).

A characteristic of the novel coronavirus disease 2019 (COVID-19) is the few cases of severely affected children. They not only rarely get symptoms but also seem to be poor transmitters. We propose that this may be explained by the mechanism of breath droplet formation, which occur during the re-opening of collapsed terminal bronchioles. Children's lungs are still developing. Compared to adults they have few alveoli and terminal bronchioles, thus less sites of aerosol formation where virus-loaded lung lining liquid can get airborne. In addition, children have a lower respiratory minute volume and tend to have a lower viral load. These points, together with the fact that asymptomatic carriers release less aerosols than symptomatic carriers support the idea that children are indeed poor transmitters of the COVID-19 virus.

Despite numerous masking recommendations from public health agencies, including the World Health Organization, editorials, and commentaries providing support for this notion, none had examined different homemade masks or demonstrated that perhaps not all cloth masks are the same. This article aims to provide evidence-based recommendations on cloth-mask materials, its design, and, importantly, its maintenance. Articles were obtained from PubMed and preprint servers up to June 10, 2020. Current evidence suggests that filtration effectiveness can range from 3% to 95%. Multiple layer (hybrid) homemade masks made from a combination of high density 100% cotton and materials with electrostatic charge would be more effective than one made from a single material. Mask fit greatly affects filtration efficiency, and adding an overhead knot or nylon overlay potentially provides the best fit for cloth masks. There is a paucity of evidence for masks maintenance as most studies are in the laboratory setting; however, switching every 4 hours as in medical masks and stored in dedicated containers while awaiting disinfection is recommended. Outside of these recommendations to improve the effectiveness of cloth masks to reduce infection transmission, there is a need for countries to set up independent testing labs for homemade masks made based on locally available materials. This can use existing occupational health laboratories usually used for accrediting masks and respirators.

Quantifying the threat that climate change poses to fine particle (PM2.5) pollution is hampered by large uncertainties in the relationship between PM2.5 and meteorology. To constrain the impact of climate change on PM2.5, statistical models are often employed in a different manner than physical–chemical models to reduce the requirement of input data. A majority of statistical models predict PM2.5 concentration (often log-transformed) as a simple function of meteorology, which could be biased due to the conversion of precursor gases to PM2.5. We reduced this bias by developing a unique statistic model where the sum of PM2.5 and the weighted precursor gases, rather than the PM2.5 alone, was predicted as a function of meteorology and a proxy of primary emissions, where the input data of PM10, CO, O3, NO x , and SO2 were obtained from routine measurements. This modification, without losing the simplicity of statistical models, reduced the mean-square error from 27 to 17% and increased the coefficient of determination from 47 to 67% in the model cross-validation using daily PM2.5 observations during 2013–2018 for 74 cities over China. We found a previously unrecognized mechanism that synoptic climate change in the past half-century might have increased low quantiles of PM2.5 more strenuously than the upper quantiles in large cities over China. Climate change during 1971–2018 was projected to increase the annual mean concentration of PM2.5 at a degree that could be comparable with the toughest-ever clean air policy during 2013–2018 had counteracted it, as inferred from the decline in the daily concentration of carbon monoxide as an inert gas. Our estimate of the impact of climate change on PM2.5 is higher than previous statistical models, suggesting that aerosol chemistry might play a more important role than previously thought in the interaction between climate change and air pollution. Our result indicated that air quality might degrade if the future synoptic climate change could continue interacting with aerosol chemistry as it had occurred in the past half-century.

The operation of laser printers can lead to the emission of high numbers of ultrafine particles. Evidence on the toxicology and adverse health effects of these particles has been mounting, however few studies have investigated the complexity of these particles in terms of their volatility, hygroscopicity and mixing state. This study utilized a Volatility Hygroscopic Tandem Differential Mobility Analyzer (VH-TDMA) to explore the internal and external mixing states of printer-generated particles. Up to 6.0 × 105 particles. cm−3 were observed during the operation of the laser printer, and these ultrafine particles could be classified into three groups, each with its own particular volatility (i.e., gradually shrinkable, suddenly shrinkable and expandable), owing to the different internal mixing states. In particular, we propose shell-core structures to explain the special volatility of these particles. In addition, whilst the majority of the generated particles were initially hydrophobic at 90% relative humidity (RH), it was observed that there were a very small number of volatilized particles (less than 5%) that shrank (i.e., decreased in size) after humidification. This study can be used as a model for investigating the complex particle formation processes in relation to secondary organic aerosols from other sources. Furthermore, our results shed light on the complexity of indoor aerosols, which should be investigated further in future indoor air quality studies. [Display omitted] •Mixing state of printer-generated particles was measured for the first time.•Three different types of particles were identified in the printer emissions.•Physical models were developed for particle formation and ageing under different printing scenarios.

Poor air quality is a leading contributor to the global disease burden and total number of deaths worldwide. Humans spend most of their time in built environments where the majority of the inhalation exposure occurs. Indoor Air Quality (IAQ) is challenged by outdoor air pollution entering indoors through ventilation and infiltration and by indoor emission sources. The aim of this study was to understand the current knowledge level and gaps regarding effective approaches to improve IAQ. Emission regulations currently focus on outdoor emissions, whereas quantitative understanding of emissions from indoor sources is generally lacking. Therefore, specific indoor sources need to be identified, characterized, and quantified according to their environmental and human health impact. The emission sources should be stored in terms of relevant metrics and statistics in an easily accessible format that is applicable for source specific exposure assessment by using mathematical mass balance modelings. This forms a foundation for comprehensive risk assessment and efficient interventions. For such a general exposure assessment model we need 1) systematic methods for indoor aerosol emission source assessment, 2) source emission documentation in terms of relevant a) aerosol metrics and b) biological metrics, 3) default model parameterization for predictive exposure modeling, 4) other needs related to aerosol characterization techniques and modeling methods. Such a general exposure assessment model can be applicable for private, public, and occupational indoor exposure assessment, making it a valuable tool for public health professionals, product safety designers, industrial hygienists, building scientists, and environmental consultants working in the field of IAQ and health. [Display omitted] •The majority of the inhalation exposure occurs in built environments.•Indoor particle emissions have very limited regulations and are not well known.•Indoor exposures are reduced by decrease of both outdoor and indoor air pollution.•Particle emission sources should be documented in an emission library.•Model development is dependent on high quality field measurements.

Evidence on the association between long-term exposure to particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) and cardiovascular disease (CVD) is scarce in developing countries. Moreover, few studies assessed the role of the PM1 (≤1.0 μm) size fraction and CVD. We investigated the associations between PM1 and PM2.5 and CVD prevalence in Chinese adults. In 2009, we randomly recruited 24,845 adults at the age of 18–74 years from 33 communities in Northeastern China. CVD status was determined by self-report of doctor-diagnosed CVD. Three-year (2006–08) average concentrations of PM1 and PM2.5 were assigned using a satellite-based exposure. We used spatial Generalized Linear Mixed Models to evaluate the associations between air pollutants and CVD prevalence, adjusting for multiple covariates. Stratified and interaction analyses and sensitivity analyses were also performed. A 10 μg/m3 increase in long-term exposure to ambient PM1 levels was associated a 12% higher odds for having CVD (OR = 1.12; 95% CI = 1.05–1.20). Compared to PM1, association between PM2.5 and CVD was lower (OR = 1.06; 95% CI = 1.01–1.11). No significant association was observed for PM1–2.5 (1–2.5 μm) size fraction (OR = 0.98; 95% CI = 0.85–1.13). Stratified analyses showed greater effect estimates in men and the elder. Long-term PM1 exposure was positively related to CVD, especially in men and the elder. In addition, PM1 may play a greater role than PM2.5 in associations with CVD. Further longitudinal studies are warranted to confirm our findings. •Studies on PM1 and PM2.5 and cardiovascular disease (CVD) are scarce in China.•We conducted a cross-sectional study in 24,845 Chinese urban dwellers.•Associations of PM1 and PM2.5 with CVD were examined.•Long-term PM1 air pollution was associated with higher odds for CVD.•PM1 plays a greater role than PM2.5 in associations with CVD.

In every breath, humans take in particles that may be deposited on the respiratory tract and exhale particles that may contain pathogens. Lidia Morawska and Giorgio Buonanno explain how physics advances are needed to understand these processes.

Our work a decade ago demonstrated that approximately 30% of the laser printers tested were high emitters of ultrafine particles (

Background Many studies have indicated the detrimental effect of ambient ozone to respiratory health in different countries. The levels of ozone in Hanoi, Vietnam are frequently above the WHO guideline but very few studies on the effects of ambient ozone on human health have been conducted in this location. This study aimed to examine the effects of ozone on hospital admission for respiratory diseases in Hanoi, by diseases, ages and seasons. Methods Hospital admissions, air pollutants and meteorological data were collected from January 2010 to June 2014. We used generalized linear models and distributed lag linear model to assess the association. In addition to full year analysis, we conducted restricted analysis of the data for two summer (from June-August) and winter (from December-February) seasons and grouped hospital admissions by diseases and ages (all ages, children 0 to 5 years and elderly >65 years). The delayed effect of ozone was assessed using lags of up to 5 days. Results Ozone has a stronger effect on the risk of hospital admission for respiratory diseases and wheeze-associated disorders in the winter. For respiratory diseases, children were affected by ozone more than other age groups in both winter and summer. Each increase of 10 mu g/m(3) of ozone is associated with an increase of 6.2% risk of admission for respiratory disease among children in the winter and 1.2% in the summer. For wheeze-associated disorders, the elderly group seemed to be more affected by ozone in full year and winter but no significant association was found between ozone and admission for wheeze-associated diseases in any age group. Conclusions Ozone is a risk factor for respiratory admission, especially amongst children under 5 years old in Hanoi, and ozone has a stronger effect in the winter than in the summer in this city.

Airborne transmission is a recognized pathway of contagion; however, it is rarely quantitatively evaluated. The numerous outbreaks that have occurred during the SARS-CoV-2 pandemic are putting a demand on researchers to develop approaches capable of both predicting contagion in closed environments (predictive assessment) and analyzing previous infections (retrospective assessment). This study presents a novel approach for quantitative assessment of the individual infection risk of susceptible subjects exposed in indoor microenvironments in the presence of an asymptomatic infected SARS-CoV-2 subject. The application of a Monte Carlo method allowed the risk for an exposed healthy subject to be evaluated or, starting from an acceptable risk, the maximum exposure time. We applied the proposed approach to four distinct scenarios for a prospective assessment, highlighting that, in order to guarantee an acceptable risk of 10 3 for exposed subjects in naturally ventilated indoor environments, the exposure time could be well below one hour. Such maximum exposure time clearly depends on the viral load emission of the infected subject and on the exposure conditions; thus, longer exposure times were estimated for mechanically ventilated indoor environments and lower viral load emissions. The proposed approach was used for retrospective assessment of documented outbreaks in a restaurant in Guangzhou (China) and at a choir rehearsal in Mount Vernon (USA), showing that, in both cases, the high attack rate values can be justified only assuming the airborne transmission as the main route of contagion. Moreover, we show that such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions, including emission and exposure parameters, leading to a highly probable event, which can be defined as a "superspreading event".

The dispersion of ions from a point source has been extensively modelled but there have been very few attempts to experimentally verify the theoretical findings. The main reason for this has been the difficulty of discriminating between cluster ion and charged particle concentrations in the air. In this paper, we describe a novel technique for the experimental determination of the dispersion of ions from a point source in air. Laboratory experiments showed that the lifetime of cluster ions in an aerosol cloud was of the order of minutes. However, once they attached to aerosols, the particles retained the charge for at least 30 min, suggesting that they may be carried long distances in natural winds. A negative air ionizer was used to produce ions and charged particles in an open field in the presence of a steady horizontal wind. A neutral cluster and air ion spectrometer was used to measure cluster ion and charged particle concentrations as a function of downwind distance from the source. The results are broadly consistent with the Gaussian dispersion model for a continuous point source. We estimate that cluster ions can be carried up to a distance of several hundred metres before they fully attach to particles which can then be carried as far as 3-4 km. Therefore, these observations have important bearing on exposure to cluster ions and charged particles downwind of ion sources such as high voltage power lines and busy roads.

Living in greener areas has many health benefits, but evidence concerning the effects on blood pressure remains mixed. We sought to assess associations between community greenness and both blood pressure and hypertension in Chinese urban dwellers, and whether the associations were mediated by air pollution, body mass index, and physical activity. We analyzed data from 24,845 adults participating in the 33 Communities Chinese Health Study, which was conducted in Northeastern China during 2009. We measured each participant's blood pressure according to a standardized protocol. We assessed community greenness using two satellite-derived vegetation indexes – the Normalized Difference Vegetation Index (NDVI) and the Soil Adjusted Vegetation Index (SAVI). Particulate matter ≤2.5 μm and nitrogen dioxide were used as proxies of ambient air pollution. We applied generalized linear mixed models to investigate the association between greenness and blood pressure. We also performed mediation analyses. Living in greener areas was associated with lower blood pressure and hypertension prevalence; an interquartile range increase in both NDVI500-m and SAVI500-m were significantly associated with reductions in systolic blood pressure of 0.82 mm Hg (95% CI: −1.13, −0.51) and 0.89 mm Hg (95% CI: −1.21, −0.57), respectively. The same increases in greenness were also significantly associated with a 5% (95% CI: 1%, 8%) and 5% (95% CI: 1%, 9%) lower odds of having hypertension, respectively. These associations remained consistent in sensitivity analyses. The associations were stronger among women than men. Air pollutants and body mass index partly mediated the associations, but there was no evidence of mediation effects for physical activity. Our findings indicate beneficial associations between community greenness and blood pressure in Chinese adults, especially for women. Air pollution and body mass index only partly mediated the associations. •Evidence on greenness and blood pressure is scarce in China.•We conducted a cross-sectional study in 24,845 Chinese urban dwellers.•Associations of greenness with blood pressure metrics were examined.•Greenness levels were beneficially associated with blood pressure.•Air pollution and BMI partly mediated the greenness-blood pressure association.

Evidence of associations between exposure to ambient air pollution and health outcomes are sparse in the South Asian region due to limited air pollution exposure and quality health data. This study investigated the potential impacts of ambient particulate matter (PM) on respiratory disease hospitalization in Kandy, Sri Lanka for the year 2019. The Generalized Additive Model (GAM) was applied to estimate the short-term effect of ambient PM on respiratory disease hospitalization. As the second analysis, respiratory disease hospitalizations during two distinct air pollution periods were analyzed. Each 10 mu g/m(3) increase in same-day exposure to PM2.5 and PM10 was associated with an increased risk of respiratory disease hospitalization by 1.95% (0.25, 3.67) and 1.63% (0.16, 3.12), respectively. The effect of PM2.5 or PM10 on asthma hospitalizations were 4.67% (1.23, 8.23) and 4.04% (1.06, 7.11), respectively (p < 0.05). The 65+ years age group had a higher risk associated with PM2.5 and PM10 exposure and hospital admissions for all respiratory diseases on the same day (2.74% and 2.28%, respectively). Compared to the lower ambient air pollution period, higher increased hospital admissions were observed among those aged above 65 years, males, and COPD and pneumonia hospital admissions during the high ambient air pollution period. Active efforts are crucial to improve ambient air quality in this region to reduce the health effects.

Low-cost air quality sensors are increasingly being used in many applications; however, many of their performance characteristics have not been adequately investigated. This study was conducted over a period of 13 months using low-cost air quality monitors, each comprising two low-cost sensors, which were subjected to a wide range of pollution sources and concentrations, relative humidity and temperature at four locations in Australia and China. The aim of the study was to establish the performance characteristics of the two low-cost sensors (a Plantower PMS1003 for PM2.5 and an Alphasense CO–B4 for carbon monoxide, CO) and the KOALA monitor as a whole under various conditions. Parameters evaluated included the inter-variability between individual monitors, the accuracy of monitors in comparison with the reference instruments, the effect of temperature and RH on the performance of the monitors, the responses of the PM2.5 sensors to different types of aerosols, and the long-term stability of the PM2.5 and CO sensors. The monitors showed high inter-correlations (r > 0.91) for both PM2.5 and CO measurements. The monitor performance varied with location, with moderate to good correlations with reference instruments for PM2.5 (0.44< R2 

Using waste paper as fuel for domestic heating is a beneficial recycling option for small island developing states where there are lacks of resources for energy and waste treatment. However, there are concerns about the impact of air pollutants emitted from the burning of the self-made paper briquettes as household air pollution is recognised as the greatest environmental risk for human. In this study, combustion tests were carried out for paper briquettes made in one Pacific island and three commercial fuels in Australia including wood briquettes, kindling firewood and coal briquettes in order to: 1) characterise the emissions of three criteria air pollutants including particulate matters, CO and NOx including their emission factors (EF) from the tested fuels; and 2) compare the EFs among the tested fuels and with others reported in the literature. The results showed that waste paper briquettes burned quickly and generated high temperature but the heat value is relatively low. Paper briquettes and coal briquettes produced higher CO concentration than the others while paper briquettes generated the highest NOx level. Only PM2.5 concentration emitted from paper briquettes was similar to kindling firewood and lower than wood briquettes. Burning of paper briquettes and wood briquettes produced particulate matter with large average count median diameter (72 and 68 nm) than coal briquette and kindling firewood (45 and 51 nm). The EFs for CO, NOx and PM2.5 of paper briquettes were within the range of EFs reported in this study as well as in the literature. Overall, the results suggested that using paper briquettes as fuel for domestic heating will not likely to generate higher level of three major air pollutants compared to other traditional fuels.

The potential role of air pollution in the worsening of health impacts of COVID-19, and the influence of the pandemic on air pollution levels in Europe is explored. This editorial outlines the major lessons learned to chart a healthy post-pandemic course.

Recently, there has been a substantial increase in the availability and use of low-cost particulate matter sensors in a wide range of air quality applications. They carry the promise of revolutionising air quality monitoring, yet considerable reservations exist regarding their performance and capabilities, thus hindering the broader-scale utilization of these devices. In order to address these concerns and assess their feasibility and accuracy for various applications, we evaluated six low-cost PM2.5 sensors (the Sharp GP2Y1010AU0F, Shinyei PPD42NS, Plantower PMS1003, Innociple PSM305, Nova SDS011 and Nova SDL607) in laboratory and field conditions using two combustion aerosols, concrete dust and ambient particles. In assessing the performance of these sensors, we focussed on indicators such as the linearity, accuracy and precision, critically differentiating between these qualities, and employed inter-comparison (the coefficient of determination, R2). In the laboratory, all sensors responded well, with an R2 > 0.91 when the PM2.5 concentration was > 50 µg m–3, as measured by the DustTrak. In particular, the PMS1003 demonstrated good accuracy and precision in both laboratory and ambient conditions. However, some limitations were noted for the tested sensors at lower concentrations. For example, the Sharp and Shinyei sensors showed poor correlations (R2 < 0.1) with the DustTrak when the ambient PM2.5 concentration was < 20 µg m–3. These results suggest that the sensors should be calibrated individually for each source in the environment of their intended use. We demonstrate that when tested appropriately and used with a full understanding of their capabilities and limitations, low-cost sensors can serve as an unprecedented aid in a broad spectrum of air quality applications, including the emerging field of citizen science.

To mitigate the concentrations of air pollutants in the atmosphere, an intervention program of replacing the converters of liquefied petroleum gas (LPG) fueled vehicles was implemented by the Hong Kong government between October 2013 and April 2014. Data of ambient volatile organic compounds (VOCs) and other trace gases continuously monitored from September 2012 to April 2017 at a roadside site were used to evaluate the continuous effectiveness of the replaced catalytic converters on the reduction of air pollutants. The measurement data showed that LPG-related VOCs (propane and n/i-butanes) and several trace gases (CO, NO and NO2) decreased significantly from before to after the program (p < 0.01). To further assess the efficiency of the program, five periods covering before the program, during the program, 1st year after the program, 2nd year after the program and 3rd year after the program were categorized. The values of propane and n/i-butanes decreased from Period-1 (before the program) to Period-2 (during the program), and from Period-2 to Periods 3-5 (after the program) (p < 0.01). In addition, the reduction rates of propane and n/i-butanes remained high and constant in Periods 3-5, suggesting that either had the vehicle owners themselves routinely replaced the converters at suitable interval afterwards, or were their vehicles caught by a remote sensing program checking excessive emissions. Source apportionment analysis indicated that LPG-fueled vehicular emissions were the top contributor to ambient VOCs in the roadside environment while the VOCs emitted from LPG-fueled vehicles indeed decreased at a rate of 421 +/- 238 ppbv/year (average +/- 95% confidence interval) from Period-1 to Period-5 (p < 0.01). Furthermore, the photochemical box model simulations revealed that the net negative contribution of VOCs and NOx emitted from LPG-fueled vehicles to O-3 production strengthened at a rate of 1.9 x 10(-2) pptv/day from Period-1 to Period-5 (p < 0.01). The findings proved the continuous effectiveness of the intervention program, and are of help to future control strategies in Hong Kong. (C) 2018 Elsevier B.V. All rights reserved.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

Background SARS-CoV-2 poses a considerable threat to those living in residential aged care facilities (RACF). RACF COVID-19 outbreaks have been characterised by the rapid spread of infection and high rates of severe disease and associated mortality. Despite a growing body of evidence supporting airborne transmission of SARS-CoV-2, current infection control measures in RACF including hand hygiene, social distancing, and sterilisation of surfaces, focus on contact and droplet transmission. Germicidal ultraviolet (GUV) light has been used widely to prevent airborne pathogen transmission. Our aim is to investigate the efficacy of GUV technology in reducing the risk of SARS-CoV-2 infection in RACF. Methods A multicentre, two-arm double-crossover, randomised controlled trial will be conducted to determine the efficacy of GUV devices to reduce respiratory viral transmission in RACF, as an adjunct to existing infection control measures. The study will be conducted in partnership with three aged care providers in metropolitan and regional South Australia. RACF will be separated into paired within-site zones, then randomised to intervention order (GUV or control). The initial 6-week period will be followed by a 2-week washout before crossover to the second 6-week period. After accounting for estimated within-zone and within-facility correlations of infection, and baseline infection rates (10 per 100 person-days), a sample size of n = 8 zones (n = 40 residents/zone) will provide 89% power to detect a 50% reduction in symptomatic infection rate. The primary outcome will be the incidence rate ratio of combined symptomatic respiratory infections for intervention versus control. Secondary outcomes include incidence rates of hospitalisation for complications associated with respiratory infection; respiratory virus detection in facility air and fomite samples; rates of laboratory confirmed respiratory illnesses and genomic characteristics. Discussion Measures that can be deployed rapidly into RACF, that avoid the requirement for changes in resident and staff behaviour, and that are effective in reducing the risk of airborne SARS-CoV-2 transmission, would provide considerable benefit in safeguarding a highly vulnerable population. In addition, such measures might substantially reduce rates of other respiratory viruses, which contribute considerably to resident morbidity and mortality. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12621000567820 (registered on 14th May, 2021).

Importance Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. Question What is the cancer burden over time at the global and national levels, measured in incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs), and how does it compare with other diseases? Findings Results of this systematic analysis show that in 2017 there were 24.5 million incident cases (16.8 million without nonmelanoma skin cancer), 9.6 million deaths, and 233.5 million DALYs due to cancer; between 2007 and 2017, incident cases increased by 33%, with the lowest increase in the most developed countries, and between 1990 and 2017 neoplasms increased among the top causes of DALYs from the sixth to the second place. Fifty-one percent of cancer cases occurred in countries of high Socio-demographic Index, but only 30% of cancer deaths and 24% of cancer DALYs. Meaning To ensure sustainable global development, increased efforts are needed in cancer prevention and in ensuring universal access to cancer care. This systematic analysis describes cancer burden for 29 cancer groups across 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Urban air pollution presents significant health risks to urban dwellers around the world. Knowledge of the levels of air pollution at various spatial locations in a city, offers insight into the personal exposure of residents and facilitates the control of air pollution. This study investigated ultrafine particles (UFP) in key microenvironments in which people spend a significant amount of their time in three suburbs of Accra (the capital city of Ghana) and in a nearby rural community (Berekuso). The ambient concentrations of UFP across the study area were also mapped. The median daily ambient UFP concentration at a reference site at Kwabenya, a suburb of Accra, was 5.8(IQR:1.6−17.1)×104cm−3. The UFP on the reference site were mainly influenced by vehicular traffic, and open-air burning in communities near the site, and by extention, wind direction. The mean (±SEM) UFP concentrations reported in five school and household microenvironments in two suburbs in Accra (Madina and Agbogbloshie) and in Berekuso ranged between 9.1×103(±7.3×102) and 1.5×105(±1.9×104)cm−3. The microenvironmental concentrations were mainly influenced by lifestyle and sociocultural factors. The results highlight the high levels of UFP in many of the microenvironments investigated, the potential health risks that UFP pose to sensitive groups, and the overall urgency for the control of air pollution in Accra. •We studied ultrafine particles (UFP) in indoors and outdoors in Ghana.•Traffic and combustion activities were the main drivers of UFP concentration levels.•UFP levels in many Ghanaian microenvironments are among the highest in the world.

This study examined the effect of short-term changes in ambient temperature on hospital admissions among children aged less than 5 years old in Hanoi, Vietnam. Data on daily hospital admissions from January 2010 to June 2014 were collected from two hospitals. Daily meteorological data were obtained for the same period. We applied time series analysis to evaluate the risk of hospitalisation related to hot and cold weather by age and causes. We found that a 1 °C decrease in minimum temperature during the cold weather months was associated with 2.2% increase in hospital admission for respiratory infection among children 3-5 years old. A 1 °C increase in diurnal temperature range (DTR) in cold weather was associated with an increase of 1.9% and 1.7% in hospitalisation for all causes and respiratory infection, respectively, among children

An increasing number of epidemiological studies have examined the association between ultrafine particles (UFP) and imbalanced autonomic control of the heart, a potential mechanism linking particulate matter air pollution to cardiovascular disease. This study systematically reviews and meta-analyzes studies on short-term effects of UFP on autonomic function, as assessed by heart rate variability (HRV). We searched PubMed and Web of Science for articles published until June 30, 2022. We extracted quantitative measures of UFP effects on HRV with a maximum lag of 15 days from single-pollutant models. We assessed the risk of bias in the included studies regarding confounding, selection bias, exposure assessment, outcome measurement, missing data, and selective reporting. Random-effects models were applied to synthesize effect estimates on HRV of various time courses. Twelve studies with altogether 1,337 subjects were included in the meta-analysis. For an increase of 10,000 particles/cm3 in UFP assessed by central outdoor measurements, our meta-analysis showed immediate decreases in the standard deviation of the normal-to-normal intervals (SDNN) by 4.0% [95% confidence interval (CI): 7.1%, −0.9%] and root mean square of successive R-R interval differences (RMSSD) by 4.7% (95% CI: 9.1%, 0.0%) within 6 h after exposure. The immediate decreases in SDNN and RMSSD associated with UFP assessed by personal measurements were smaller and borderline significant. Elevated UFP were also associated with decreases in SDNN, low-frequency power, and the ratio of low-frequency to high-frequency power when pooling estimates of lags across hours to days. We did not find associations between HRV and concurrent-day UFP exposure (daily average of at least 18 h) or exposure at lags ≥ one day. Our study indicates that short-term exposure to ambient UFP is associated with decreased HRV, predominantly as an immediate response within hours. This finding highlights that UFP may contribute to the onset of cardiovascular events through autonomic dysregulation. [Display omitted] •Twelve studies with 1,337 subjects were synthesized in the meta-analysis.•Short-term ultrafine particles (UFP) exposure was associated with decreased HRV.•The UFP effects on HRV were most prominent within 6 h after exposure.•Stronger UFP effects were reported in populations without coronary artery diseases.•UFP may contribute to cardiovascular events through autonomic dysregulation.

Monosaccharides are important tracers of pollution aerosol from biomass burning. Air sampling of monosaccharides is often conducted using active samplers. However, applicability of sampling monosaccharides using polyurethane foam passive air samplers (PUF-PASs) has not been investigated, since passive air samplers are often applied to monitor semivolatile organic contaminants in large scale and remote area. Our study successfully collected atmospheric monosaccharides using PUF-PASs, providing a valuable tool for monosaccharides sampling. PUF-PAS sampling rates for individual monosaccharides were calibrated using an active sampler for 92 days, and were 1.1, 1.5, and 1.1 m(3)/d for levoglucosan, mannosan, and galactosan, respectively. Degradation of monosaccharides in PUF-PAS was demonstrated to be negligible by spike test of C-13-labeled levoglucosan. Furthermore, passive sampling was carried out at 11 sites in the Pearl River Delta of Southern China from January to April and July to September of 2015. Monosaccharide concentrations derived from PUF-PASs were comparable with the reported data obtained by active sampling, demonstrating that the PUF-PAS approach is valid for monosaccharides monitoring. On the basis of our approach, we found that there is a clear correlation between the monosaccharide concentrations and the MODIS fire activities during January-April.

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

Living in areas with more vegetation (referred to as residential greenness) may be associated with cardiovascular disease (CVD), but little data are available from low- and middle-income countries. In addition, it remains unclear whether the presence of cardiometabolic disorders modifies or mediates the association between residential greenness and CVD. To evaluate the associations between residential greenness, cardiometabolic disorders, and CVD prevalence among adults in China. This analysis was performed as part of the 33 Communities Chinese Health Study, a large population-based cross-sectional study that was conducted in 33 communities (ranging from 0.25-0.64 km2) in 3 cities within the Liaoning province of northeastern China between April 1 and December 31, 2009. Participants included adults aged 18 to 74 years who had resided in the study area for 5 years or more. Greenness levels surrounding each participant's residential community were assessed using the normalized difference vegetation index and the soil-adjusted vegetation index from 2010. Lifetime CVD status (including myocardial infarction, heart failure, coronary heart disease, cerebral thrombosis, cerebral hemorrhage, cerebral embolism, and subarachnoid hemorrhage) was defined as a self-report of a physician diagnosis of CVD at the time of the survey. Cardiometabolic disorders, including hypertension, diabetes, dyslipidemia, and overweight or obese status, were measured and defined clinically. Generalized linear mixed models were used to evaluate the association between residential greenness levels and CVD prevalence. A 3-way decomposition method was used to explore whether the presence of cardiometabolic disorders mediated or modified the association between residential greenness and CVD. Data were analyzed from October 10 to May 30, 2020. Lifetime CVD status, the presence of cardiometabolic disorders, and residential greenness level. Among 24 845 participants, the mean (SD) age was 45.6 (13.3) years, and 12 661 participants (51.0%) were men. A total of 1006 participants (4.1%) reported having a diagnosis of CVD. An interquartile range (1-IQR) increase in the normalized difference vegetation index within 500 m of a community was associated with a 27% lower likelihood (odds ratio [OR], 0.73; 95% CI, 0.65-0.83; P 

Background Beneficial effects of greenness on birth outcomes have been reported, but few studies have investigated the associations in both urban and non-urban settings. We aimed to evaluate and compare linear and nonlinear associations between greenness and birth outcomes in urban and non-urban settings. Methods From October 2015 to December 2018, participants were recruited into the Maoming Birth Cohort Study. A total of 11 258 live birth records were obtained. Greenness exposure was assessed using the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Linear regression and nonlinear restricted cubic spline models were implemented to investigate the associations between greenness and birthweight, birth length, gestational age, preterm birth, low birthweight, small for gestational age and the potential for effect variation under urban or non-urban settings, after adjusting for covariates. Results A 0.1-unit increase in NDVI-500m was significantly associated with an increase of 35.4 g in birthweight [95% confidence interval (CI): 13.2, 57.7], 0.15 cm in birth length (95% CI: 0.03, 0.26), 0.88 days in gestational age (95% CI: 0.05, 1.71) and lower odds of low birthweight [odds ratio (OR) = 0.69, 95% CI: 0.56, 0.85] and preterm birth (OR = 0.70, 95% CI: 0.58, 0.85). No association with head circumference was observed. For all outcomes, no significant linear associations were observed among non-urban dwellers. Inversed 'U-shaped' associations between greenness exposure and birth outcomes were observed in the total study population. Conclusions Greenness exposure was associated with increased gestational age, birthweight and birth length in urban dwellers. Nonlinear associations assessed by restricted cubic splines suggested that health benefits could be larger when increasing greenness levels from low to medium compared with increasing greenness from medium to high levels. Further studies adopting nonlinear methods are warranted to verify our findings.

STOFFENMANAGER® and the Advanced REACH Tool (ART) are recommended tools by the European Chemical Agency for regulatory chemical safety assessment. The models are widely used and accepted within the scientific community. STOFFENMANAGER® alone has more than 37 000 users globally and more than 310 000 risk assessment have been carried out by 2020. Regardless of their widespread use, this is the first study evaluating the theoretical backgrounds of each model. STOFFENMANAGER® and ART are based on a modified multiplicative model where an exposure base level (mg m-3) is replaced with a dimensionless intrinsic emission score and the exposure modifying factors are replaced with multipliers that are mainly based on subjective categories that are selected by using exposure taxonomy. The intrinsic emission is a unit of concentration to the substance emission potential that represents the concentration generated in a standardized task without local ventilation. Further information or scientific justification for this selection is not provided. The multipliers have mainly discrete values given in natural logarithm steps (…, 0.3, 1, 3, …) that are allocated by expert judgements. The multipliers scientific reasoning or link to physical quantities is not reported. The models calculate a subjective exposure score, which is then translated to an exposure level (mg m-3) by using a calibration factor. The calibration factor is assigned by comparing the measured personal exposure levels with the exposure score that is calculated for the respective exposure scenarios. A mixed effect regression model was used to calculate correlation factors for four exposure group [e.g. dusts, vapors, mists (low-volatiles), and solid object/abrasion] by using ~1000 measurements for STOFFENMANAGER® and 3000 measurements for ART. The measurement data for calibration are collected from different exposure groups. For example, for dusts the calibration data were pooled from exposure measurements sampled from pharmacies, bakeries, construction industry, and so on, which violates the empirical model basic principles. The calibration databases are not publicly available and thus their quality or subjective selections cannot be evaluated. STOFFENMANAGER® and ART can be classified as subjective categorization tools providing qualitative values as their outputs. By definition, STOFFENMANAGER® and ART cannot be classified as mechanistic models or empirical models. This modeling algorithm does not reflect the physical concept originally presented for the STOFFENMANAGER® and ART. A literature review showed that the models have been validated only at the 'operational analysis' level that describes the model usability. This review revealed that the accuracy of STOFFENMANAGER® is in the range of 100 000 and for ART 100. Calibration and validation studies have shown that typical log-transformed predicted exposure concentration and measured exposure levels often exhibit weak Pearson's correlations (r is

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

The COVID-19 pandemic has brought an unprecedented crisis to the global health sector. When discharging COVID-19 patients in accordance with throat or nasal swab protocols using RT-PCR, the potential risk of reintroducing the infection source to humans and the environment must be resolved. Here, 14 patients including 10 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) in four hospitals with applied natural ventilation and disinfection practices in Wuhan. Here we discovered that 22.2% of COVID-19 patients (n = 9), who were ready for hospital discharge based on current guidelines, had SARS-CoV-2 in their exhaled breath (~105 RNA copies/m3). Although fewer surface swabs (3.1%, n = 318) tested positive, medical equipment such as face shield frequently contacted/used by healthcare workers and the work shift floor were contaminated by SARS-CoV-2 (3–8 viruses/cm2). Three of the air samples (n = 44) including those collected using a robot-assisted sampler were detected positive by a digital PCR with a concentration level of 9–219 viruses/m3. RT-PCR diagnosis using throat swab specimens had a failure rate of more than 22% in safely discharging COVID-19 patients who were otherwise still exhaling the SARS-CoV-2 by a rate of estimated ~1400 RNA copies per minute into the air. Direct surface contact might not represent a major transmission route, and lower positive rate of air sample (6.8%) was likely due to natural ventilation (1.6–3.3 m/s) and regular disinfection practices. While there is a critical need for strengthening hospital discharge standards in preventing re-emergence of COVID-19 spread, use of breath sample as a supplement specimen could further guard the hospital discharge to ensure the safety of the public and minimize the pandemic re-emergence risk. [Display omitted] •Recovering COVID-19 patients (22.2%) still exhale thousands of SARS-CoV-2 per minute.•Hospital air (6.8%) was shown to have SARS-CoV-2 levels of 9–219 COVID-19 viruses/m3.•Surface swabs had a level of 3–8 viruses/cm2 with a SARS-CoV-2 positive rate of 3.1%.

[Display omitted] •Novel combination of close proximity and room-scale risk assessment approaches.•Prediction of contagious risk due to SARS-CoV-2 respiratory infection in buses.•For urban buses the close proximity significantly affects the reproductive number.•For long-distance buses a full occupancy of the bus can hardly be maintained.•Appropriate filtration of recirculated air and FFP2 masks permit full occupancy. Public transport environments are thought to play a key role in the spread of SARS-CoV-2 worldwide. Indeed, high crowding indexes (i.e. high numbers of people relative to the vehicle size), inadequate clean air supply, and frequent extended exposure durations make transport environments potential hotspots for transmission of respiratory infections. During the COVID-19 pandemic, generic mitigation measures (e.g. physical distancing) have been applied without also considering the airborne transmission route. This is due to the lack of quantified data about airborne contagion risk in transport environments. In this study, we apply a novel combination of close proximity and room-scale risk assessment approaches for people sharing public transport environments to predict their contagion risk due to SARS-CoV-2 respiratory infection. In particular, the individual infection risk of susceptible subjects and the transmissibility of SARS-CoV-2 (expressed through the reproduction number) are evaluated for two types of buses, differing in terms of exposure time and crowding index: urban and long-distance buses. Infection risk and reproduction number are calculated for different scenarios as a function of the ventilation rates (both measured and estimated according to standards), crowding indexes, and travel times. The results show that for urban buses, the close proximity contribution significantly affects the maximum occupancy to maintain a reproductive number of 80%) would be needed.

The widely used Air Quality Index (AQI) has been criticized due to its inaccuracy, leading to the development of the air quality health index (AQHI), an improvement on the AQI. However, there is currently no consensus on the most appropriate construction strategy for the AQHI. In this study, we aimed to evaluate the utility of AQHIs constructed by different models and health outcomes, and determine a better strategy. Based on the daily time-series outpatient visits and hospital admissions from 299 hospitals (January 2016–December 2018), and mortality (January 2017–December 2019) in Guangzhou, China, we utilized cumulative risk index (CRI) method, Bayesian multi-pollutant weighted (BMW) model and standard method to construct AQHIs for different health outcomes. The effectiveness of AQHIs constructed by different strategies was evaluated by a two-stage validation analysis and examined their exposure-response relationships with the cause-specific morbidity and mortality. Validation by different models showed that AQHI constructed with the BMW model (BMW-AQHI) had the strongest association with the health outcome either in the total population or subpopulation among air quality indexes, followed by AQHI constructed with the CRI method (CRI-AQHI), then common AQHI and AQI. Further validation by different health outcomes showed that AQHI constructed with the risk of outpatient visits generally exhibited the highest utility in presenting mortality and morbidity, followed by AQHI constructed with the risk of hospitalizations, then mortality-based AQHI and AQI. The contributions of NO2 and O3 to the final AQHI were prominent, while the contribution of SO2 and PM2.5 were relatively small. The BMW model is likely to be more effective for AQHI construction than CRI and standard methods. Based on the BMW model, the AQHI constructed with the outpatient data may be more effective in presenting short-term health risks associated with the co-exposure to air pollutants than the mortality-based AQHI and existing AQIs. [Display omitted] •Morbidity data from 299 hospitals in Guangzhou, China were used for the improved AQHI validation and construction.•The utility of AQHIs constructed with two updated multi-pollutant models and three health outcomes were compared.•AQHI constructed with BMW model and outpatient visit data exhibited relatively higher effectiveness in communicating risks.

Exposure to air pollution in the form of fine particulate matter (PM2.5) is known to cause diseases and cancers. Consequently, the public are increasingly seeking health warnings associated with levels of PM2.5 using mobile phone applications and websites. Often, these existing platforms provide one-size-fits-all guidance, not incorporating user specific personal preferences. This study demonstrates an innovative approach using Bayesian methods to support personalised decision making for air quality. We present a novel hierarchical spatio-temporal model for city air quality that includes buildings as barriers and captures covariate information. Detailed high resolution PM2.5 data from a single mobile air quality sensor is used to train the model, which is fit using R-INLA to facilitate computation at operational timescales. A method for eliciting multi-attribute utility for individual journeys within a city is then given, providing the user with Bayes-optimal journey decision support. As a proof-of-concept, the methodology is demonstrated using a set of journeys and air quality data collected in Brisbane city centre, Australia.

The spread of respiratory diseases via aerosol particles in indoor settings is of significant concern. The SARS-CoV-2 virus has been found to spread widely in confined enclosures like hotels, hospitals, cruise ships, prisons, and churches. Particles exhaled from a person indoors can remain suspended long enough for increasing the opportunity for particles to spread spatially. Careful consideration of the ventilation system is essential to minimise the spread of particles containing infectious pathogens. Previous studies have shown that indoor airflow induced by opened windows would minimise the spread of particles. However, how outdoor airflow through an open window influences the indoor airflow has not been considered. The aim of this study is to provide a clear understanding of the indoor particle spread across multiple rooms, in a situation similar to what is found in quarantine hotels and cruise ships, using a combination of HVAC (Heating, Ventilation and Air-Conditioning) ventilation and an opening window. Using a previously validated mathematical model, we used 3D CFD (computational fluid dynamics) simulations to investigate to what extent different indoor airflow scenarios contribute to the transport of a single injection of particles (1.3μm) in a basic 3D multi-room indoor environment. Although this study is limited to short times, we demonstrate that in certain conditions approximately 80% of the particles move from one room to the corridor and over 60% move to the nearby room within 5 to 15 s. Our results provide additional information to help identifying relevant recommendations to limit particles from spreading in enclosures. •CFD simulations show that an opened window has a dominant effect in the indoor settings.•An open window contributes to the transport of particles across multiple rooms.•Within seconds, exhaled particles can spread to the corridor and opposite room.•Simulation outcomes provide knowledge of lowering indoor particle spread.

Barrier techniques, such as plastic sheets or intubation boxes, are purported to offer additional protection for healthcare workers. To assess the functionality, perceived safety, droplet protection, and aerosol protection of several barrier techniques. Firstly, a simulation study with 12 different laryngoscopists was conducted to assess the time taken to perform an intubation (via direct laryngoscopy, via video laryngoscopy, and via a bougie) with four different barrier techniques (personal protective equipment only, a plastic sheet, a tented plastic sheet, and an intubation box). Secondly, a cough at the time of intubation was simulated using ultraviolet dye to assess the spread of droplets; and thirdly, smoke was used to assess the spread of aerosols. Intubation time using the box was noninferior to using no barrier. Based on subjective ratings by the laryngoscopists, the most functional technique was no barrier followed by the intubation box, then the tented sheet, and then the plastic sheet. The technique that conferred the highest feeling of safety to the laryngoscopists was the intubation box, followed by the tented sheet, then no barrier, and then the plastic sheet. All the barriers prevented the ultraviolet dye contaminating the head and torso of the laryngoscopist. Smoke remained within the intubation box if plastics sheets were used to cover the openings and suction was ineffective at clearing it. With no barrier in place, smoke was effectively cleared away from the patient in a theater with laminar flow but tended to spread up toward the laryngoscopist in a room without laminar flow. A well-designed intubation box is an effective barrier against droplets and is noninferior to no barrier in relation to intubation time. However, a box interferes with laminar flow in theaters with formal ventilation systems and may result in accumulation of aerosols if it is completely enclosed.

AbstractObjectivesTo use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors.DesignSystematic analysis.SettingParticipants were aged ≥70 from 204 countries and territories, 1990-2019.Main outcomes measuresYears of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods.ResultsGlobally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non-communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE-70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks.ConclusionsLife expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervention programmes to improve wellbeing among older adults.

Epidemiological studies have linked outdoor PM2.5 concentrations to a range of health effects, although people spend most of the time indoors. To better understand how individuals' exposure vary as they move between different indoor and outdoor microenvironments, our study investigated personal PM2.5 exposure and exposure intensity of 14 adult volunteers over one week (five weekdays and one weekend), using low-cost personal monitors, recording PM2.5 concentrations in 5 min intervals. Further, the study evaluated community perception of air pollution exposure during the recruitment and engagement with the volunteers. We found that people with tertiary education across all ages had greater interest in participating, with younger people being interested regardless of the level of education. The derived exposures and exposure intensities differed between weekdays and the weekend due to larger variations in individuals' daily routines. In general, time spent at home and engaged in indoor activities was associated with the highest personal PM2.5 exposure and exposure intensity on both, week and weekend days, implying the significance of both duration of the exposure and the indoor PM2.5 concentrations. The results showed no relationship between personal exposures and indoor characteristics of home (ventilation, building age and cooktop), which are expected to be due to the study's small sample size. The observed PM2.5 > 10 μg m−3 were significantly higher for distances

The aim of this study was to summarize the extent of occupants' exposure to nitrogen dioxide (NO2) in European school and kindergarten buildings. Google Scholar and PubMed were used to search the literature. The calculated median, as well as the mean, concentrations of NO2 in school (median 20.8 µg/m3; mean 26.1 µg/m3) and kindergarten (median 17.2 µg/m3; mean 35.5 µg/m3) buildings were found to be below the World Health Organization (WHO)'s guideline of 40 µg/m3 for the annual mean NO2 concentration. However, mean O2 concentrations in many studies were over 40 µg/m3, indicating situations where the WHO guideline is exceeded. Outdoor levels of NO2 are a reliable predictor of indoor NO2 levels across seasons, with median Indoor/Outdoor (I/O) ratios of 0.7 and 0.8 in school and kindergarten environments, respectively. These findings support the importance of mitigation measures to reduce ambient NO2 levels, and to prevent high levels of NO2 exposure in school and ki ndergarten buildings.

The aim of this study was to review and synthesize the existing knowledge of the effects of ultrafine particles [UFPs] with a specific focus on children’s health. An extensive literature search identified 16 studies fulfilling the criteria set for the review. One of the most important findings of the review was that, in general, there is an association between children’s health and exposure to UFPs, especially among children with respiratory diseases, who commonly experience alterations in inflammatory biomarkers and deterioration in lung function as a result of UFP exposure. Notably, the health effects of UFPs are related to their ability to penetrate through different systems of the body due to their small size.

Statistical modelling has been successfully used to estimate the variations of NO2 concentration, but employing new modelling techniques can make these estimations far more accurate. To do so, for the first time in application to spatiotemporal air pollution modelling, we employed a soft computing algorithm called adaptive neuro-fuzzy inference system (ANFIS) to estimate the NO2 variations. Comprehensive data sets were investigated to determine the most effective predictors for the modelling process, including land use, meteorological, satellite, and traffic variables. We have demonstrated that using selected satellite, traffic, meteorological, and land use predictors in modelling increased the R-2 by 21%, and decreased the root mean square error (RMSE) by 47% compared with the model only trained by land use and meteorological predictors. The ANFIS model found to have better performance and higher accuracy than the multiple regression model. Our best model, captures 91% of the spatiotemporal variability of monthly mean NO2 concentrations at 1 km spatial resolution (RMSE 1.49 ppb) in a selected area of Australia. (c) 2017 Elsevier Ltd. All rights reserved.

Living in greener places may protect against obesity, but epidemiological evidence is inconsistent and mainly comes from developed nations. We aimed to investigate the association between greenness and obesity in Chinese adults and to assess air pollution and physical activity as mediators of the association. We recruited 24,845 adults from the 33 Communities Chinese Health Study in 2009. Central and peripheral obesity were defined by waist circumference (WC) and body mass index (BMI), respectively, based on international obesity standards. The Normalized Difference Vegetation Index (NDVI) was used to quantify community greenness. Two-level logistic and generalized linear mixed regression models were used to evaluate the association between NDVI and obesity, and a conditional mediation analysis was used also performed. In the adjusted models, an interquartile range increase in NDVI500-m was significantly associated with lower odds of peripheral 0.80 (95% confidence interval [CI]: 0.74-0.87) and central obesity 0.88 (95% CI: 0.83-0.93). Higher NDVI values were also significantly associated with lower BMI. Age, gender, and household income significantly modified associations between greenness and obesity, with stronger associations among women, older participants, and participants with lower household incomes. Air pollution mediated 2.1-20.8% of the greenness-obesity associations, but no mediating effects were observed for physical activity. In summary, higher community greenness level was associated with lower odds of central and peripheral obesity, especially among women, older participants, and those with lower household incomes. These associations were partially mediated by air pollutants. Future well-designed longitudinal studies are needed to confirm our findings. (C) 2019 Elsevier B.V. All rights reserved.

Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7.4 years (95% uncertainty interval 74-7.8), from 65.6 years (65.3-65- 8) in 1990 to 73.0 years (72.7-73.3) in 2017. The increase in years of life varied from 5.1 years (5.0-5.3) in high SDI countries to 12.0 years (11.3-12.8) in low SDI countries. Of the additional years of life expected at birth, 26.3% (20.1-33.1) were expected to be spent in poor health in high SDI countries compared with 11.7% (8.8-15.1) in low-middle SDI countries. HALE at birth increased by 6.3 years (5.9-6.7), from 57.0 years (54.6-59.1) in 1990 to 63.3 years (60.5-65.7) in 2017. The increase varied from 3.8 years (3.4-4.1) in high SDI countries to 10.5 years (9.8-11.2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1.0 year (0.4-1.7) in Saint Vincent and the Grenadines (62.4 years [59.9-64.7] in 1990 to 63.5 years [60.9-65.8] in 2017) to 23.7 years (21.9-25.6) in Eritrea (30.7 years [28.9-32.2] in 1990 to 54.4 years [51.5-57.1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1.4 years (0.6-2.3) in Algeria to 11.9 years (10.9-12.9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75.8 years [72.4-78.7]) and males (72.6 years [69 " 8-75.0]) and the lowest estimates were in Central African Republic (47.0 years [43.7-50.2] for females and 42.8 years [40.1-45.6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41.3% (38.8-43.5) for communicable diseases and by 49"8% (47.9-51.6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40.1% (36.8-43.0), although age-standardised DALY rates decreased by 18.1% (16.0-20.2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low S DI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

Spraying roads with water on a large scale in Chinese cities is one of the supplementary precaution or mitigation actions implemented to control severe air pollution events or heavy haze-fog events in which the mechanisms causing them are not yet fully understood. These air pollution events were usually characterized by higher air humidity. Therefore, there may be a link between this action and air pollution. In the present study, the impact of water spraying on the PM2.5 concentration and humidity in air was assessed by measuring chemical composition of the water, undertaking a simulated water spraying experiment, measuring residues and analyzing relevant data. We discovered that spraying large quantities of tap or river water on the roads leads to increased PM2.5 concentration and humidity, and that daily continuous spraying produces a cumulative effect on air pollution. Spraying the same amount of water produces greater increases in humidity and PM2.5 concentration during cool autumn and winter than during hot summer. Our results demonstrate that spraying roads with water increases, rather than decreases, the concentration of PM2.5 and thus is a new source of anthropogenic aerosol and air pollution. The higher vapor content and resultant humidity most likely create unfavorable meteorological conditions for the dispersion of air pollution in autumn and winter with low temperature.

ABSTRACT Background and objective Aerosol transmission of Pseudomonas aeruginosa has been suggested as a possible mode of respiratory infection spread in patients with cystic fibrosis (CF); however, whether this occurs in other suppurative lung diseases is unknown. Therefore, we aimed to determine if (i) patients with bronchiectasis (unrelated to CF) or chronic obstructive pulmonary disease (COPD) can aerosolize P. aeruginosa during coughing and (ii) if genetically indistinguishable (shared) P. aeruginosa strains are present in these disease cohorts. Methods People with bronchiectasis or COPD and P. aeruginosa respiratory infection were recruited for two studies. Aerosol study: Participants (n = 20) underwent cough testing using validated cough rigs to determine the survival of P. aeruginosa aerosols in the air over distance and duration. Genotyping study: P. aeruginosa sputum isolates (n = 95) were genotyped using the iPLEX20SNP platform, with a subset subjected to the enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC‐PCR) assay to ascertain their genetic relatedness. Results Aerosol study: Overall, 7 of 20 (35%) participants released P. aeruginosa cough aerosols during at least one of the cough aerosol tests. These cough aerosols remained viable for 4 m from the source and for 15 min after coughing. The mean total aerosol count of P. aeruginosa at 2 m was two colony‐forming units. Typing study: No shared P. aeruginosa strains were identified. Conclusion Low viable count of P. aeruginosa cough aerosols and a lack of shared P. aeruginosa strains observed suggest that aerosol transmission of P. aeruginosa is an unlikely mode of respiratory infection spread in patients with bronchiectasis and COPD. Our study shows that patients with bronchiectasis and chronic obstructive pulmonary disease (COPD) can release potentially infectious aerosols during coughing; however, no shared stains of Pseudomonas aeruginosa were identified in our study. The results suggest that aerosol transmission is an unlikely mode of cross‐infection in patients with bronchiectasis and COPD. Watch the video  See related Editorial

Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations. Educational attainment is an important social determinant of maternal, newborn, and child health(1-3). As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting(4-6). The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness(7,8); however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health(9-11). Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries(12-14). By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.

Black carbon (BC) is a significant component of atmospheric particulate matter, especially in areas affected by combustion emissions. Despite the fact that air pollution is a great concern in Vietnam, there are no studies on the level of BC in the outdoor and indoor environment. In this exploratory study, an assessment of urban BC concentrations was conducted through monitoring of both outdoor and indoor BC concentrations in three households and one working office at different locations across Hanoi. PM2.5 and meteorology data were also obtained for this monitoring period to evaluate the association between them and the outdoor BC concentration. Overall, the mean indoor and mean outdoor BC concentrations by 30 second-logs for the monitoring period were 4.42 μg/m3 and 4.89 μg/m3, respectively. Time-series analysis of paired indoor and outdoor BC concentrations suggested that indoor BC level was usually influenced by outdoor BC level (r = 0.78, p 

Background: Although it is recognized that ozone causes acute and chronic health effects and that even trace amounts of ozone are potentially deleterious to human health, information about global and local exposures to ozone in different indoor environments is limited. To synthesize the existing knowledge, this review analyzes the magnitude of and the trends in global and local exposure to ozone in schools and offices and the factors controlling the exposures. Methods: In conducting the literature review, Web of Science, SCOPUS, Google Scholar, and PubMed were searched using 38 search terms and their combinations to identify manuscripts, reports, and directives published between 1973 and 2018. The search was then extended to the reference lists of relevant articles. Results: The calculated median concentration of ozone both in school (8.50 mu g/m(3)) and office (9.04 mu g/m(3)) settings was well below the WHO guideline value of 100 mu g/m(3) as a maximum 8 h mean concentration. However, a large range of average concentrations of ozone was reported, from 0.8-114 mu g/m(3) and from 0 to 96.8 mu g/m(3) for school and office environments, respectively, indicating situations where the WHO values are exceeded. Outdoor ozone penetrating into the indoor environment is the main source of indoor ozone, with median I/O ratios of 0.21 and 0.29 in school and office environments, respectively. The absence of major indoor ozone sources and ozone sinks, including gas-phase reactions and deposition, are the reasons for lower indoor than outdoor ozone concentrations. However, there are indoor sources of ozone that are of significance in certain indoor environments, including printers, photocopiers, and many other devices and appliances designed for indoor use (e.g., air cleaners), that release ozone either intentionally or unintentionally. Due to significantly elevated outdoor ozone concentrations during summer, summer indoor concentrations are typically elevated. In addition, the age of a building and various housing aspects (carpeting, air conditioning, window fans, and window openings) have been significantly associated with indoor ozone levels. Conclusions: The existing means for reducing ozone and ozone reaction products in school and office settings are as follows: 1) reduce penetration of outdoor ozone indoors by filtering ozone from the supply air; 2) limit the use of printers, photocopiers, and other devices and appliances that emit ozone indoors; 3) limit gas-phase reactions by limiting the use of materials and products (e.g. cleaning chemicals) the emissions of which react with ozone.

Bioaerosols are recognized as one of the main transmission routes for infectious diseases and are responsible for other various types of health effects through inhalation and potential ingestion. Associating exposure with bioaerosol and health problems is challenging, and adequate exposure monitoring is a top priority for aerosol scientists. The multiple factors affecting bioaerosol content, the variability in the focus of each bioaerosol exposure study, and the variations in experimental design and the standardization of methods make bioaerosol exposure studies very difficult. Therefore, the health impacts of bioaerosol exposure are still poorly understood. This paper presents a brief description of a state-of-the-art development in bioaerosol exposure studies supported by studies on several related subjects. The main objective of this paper is to propose new considerations for bioaerosol exposure guidelines and the development of tools and study designs to better interpret bioaerosol data. The principal observations and findings are the discrepancy of the applicable methods in bioaerosol studies that makes result comparison impossible. Furthermore, the silo mentality helps in creating a bigger gap in the knowledge accumulated about bioaerosol exposure. Innovative and original ideas are presented for aerosol scientists and health scientists to consider and discuss. Although many examples cited herein are from occupational exposure, the discussion has relevance to any human environment. This work gives concrete suggestions for how to design a full bioaerosol study that includes all of the key elements necessary to help understand the real impacts of bioaerosol exposure in the short term. The creation of the proposed bioaerosol public database could give crucial information to control the public health. Implications: How can we move toward a bioaerosol exposure guidelines? The creation of the bioaerosol public database will help accumulate information for long-term association studies and help determine specific exposure biomarkers to bioaerosols. The implementation of such work will lead to a deeper understanding and more efficient utilization of bioaerosol studies to prevent public health hazards.

PM10-associated potential toxic elements (PTEs) can enter the respiratory system and cause health problems. In the current study, the health risk indices caused by PM10 inhalation by adults, children, and infants in 158 European cities between 2013 and 2019 were studied to determine if Europeans were adversely affected by carcinogenic and non-carcinogenic factors or not. The Mann–Kendall trend test examined PM10's increasing or decreasing trend. Random Forest analysis was also used to analyse meteorological factors affecting PM10 in Europe. Hazard quotient and cancer risk were estimated using PM10-associated PTEs. Our results showed a decline in continental PM10 concentrations. The correlation between PM10 concentrations and temperature (−0.40), PBLH (−0.39), and precipitation were statistically strong (−0.21). The estimated Pearson correlation coefficients showed a statistically strong positive correlation between As & Pb, As & Cd, and Cd & Pb during 2013–2019, indicating a similar origin. PTEs with hazard quotients below one, regardless of subpopulation type, posed no noncancerous risk to Europeans. The hazard quotient values positively correlated with time, possibly due to elevated PTE levels. In our study on carcinogen pollution in Europe between 2013 and 2019, we found unacceptable levels of As, Cd, Ni, and Pb among adults, children, and infants. Carcinogenic risk rates were highest for children, followed by infants, adult women, and adult men. Therefore, besides monitoring and mitigating PM concentrations, effective control of PM sources is also needed. [Display omitted] •Health risk exposure by inhalation to PM10 in Europe was assessed.•The health risk indexes caused by the PM10 inhalation were estimated.•In Europe, a general decreasing trend in PM10 concentrations was observed.•For the PTEs, there were no non-cancerous risks to European inhabitants.•PTEs pose cancerous risks to European inhabitants.

The airborne route is a potential pathway in the person-to-person transmission of bacterial strains among cystic fibrosis (CF) populations. In this cross-sectional study, we investigate the physical properties and survival of common non-Pseudomonas aeruginosa CF pathogens generated during coughing. We conclude that Gram-negative bacteria and Staphylococcus aureus are aerosolised during coughing, can travel up to 4 m and remain viable within droplet nuclei for up to 45 min. These results suggest that airborne person-to-person transmission is plausible for the CF pathogens we measured.

The process-specific emission of volatile organic compounds (VOCs) from a petroleum refinery in the Pearl River Delta, China was monitored to assess the health risk from VOCs to workers of this refinery. Over 60 VOCs were detected in the air samples collected from various sites in the refining, basic chemical, and wastewater treatment areas of the refinery using gas chromatography-mass spectrometry/flame ionization detection. The health risks of VOCs to the refinery workers were assessed using US Environmental Protection Agency (US EPA) and American Conference of Governmental Industrial Hygienists (ACGIH) methods. Monte Carlo simulation and sensitivity analysis were implemented to assess the uncertainty of the health risk estimation. The emission results showed that C5-C6 alkanes, including 2-methylpentane (17.6%), 2,3-dimethylbutane (15.4%) and 3-methylpentane (7.7%), were the major VOCs in the refining area. p-Diethylbenzene (9.3%), 2-methylpentane (8.1%) and m-diethylbenzene (6.8%) were dominant in the basic chemical area, and 2-methylpentane (20.9%), 2,3-dimethylbutane (11.4%) and 3-methylpentane (6.5%) were the most abundant in the wastewater treatment area. For the non-cancer risk estimated using the US EPA method, the total hazard ratio in the basic chemical area was the highest (3.1 × 103), owing to the highest level of total concentration of VOCs. For the cancer risk, the total cancer risks were very high, ranging from 2.93 × 10−3 (in the wastewater treatment area) to 1.1 × 10−2 (in the basic chemical area), suggesting a definite risk. Using the ACGIH method, the total occupational exposure cancer risks of VOCs in the basic chemical area were the highest, being much higher than those of refining and wastewater treatment areas. Among the areas, the total occupational exposure risks in the basic chemical and refining areas were >1, which suggested a cancer threat to workers in these areas. Sensitivity analysis suggested that improving the accuracy of VOC concentrations themselves in future research would advance the health risk assessment. [Display omitted] •We investigated the process-specific emission of VOCs from a petroleum refinery in China.•The health risks of VOCs to the refinery workers were assessed using two different methods.•There exists definite cancer risk for all the monitored areas using the USEPA method.•There is cancer threat to workers in the chemical and refining areas with the ACGIH method. This process-specific VOC emission study revealed occupational exposure cancer risks associated with petroleum refineries, particularly in the chemical and refining areas.

People with cystic fibrosis (CF) generate Pseudomonas aeruginosa in droplet nuclei during coughing. The use of surgical masks has been recommended in healthcare settings to minimize pathogen transmission between patients with CF. To determine if face masks and cough etiquette reduce viable P. aeruginosa aerosolized during coughing. Twenty-five adults with CF and chronic P. aeruginosa infection were recruited. Participants performed six talking and coughing maneuvers, with or without face masks (surgical and N95) and hand covering the mouth when coughing (cough etiquette) in an aerosol-sampling device. An Andersen Cascade Impactor was used to sample the aerosol at 2 meters from each participant. Quantitative sputum and aerosol bacterial cultures were performed, and participants rated the mask comfort levels during the cough maneuvers. During uncovered coughing (reference maneuver), 19 of 25 (76%) participants produced aerosols containing P. aeruginosa, with a positive correlation found between sputum P. aeruginosa concentration (measured as cfu/ml) and aerosol P. aeruginosa colony-forming units. There was a reduction in aerosol P. aeruginosa load during coughing with a surgical mask, coughing with an N95 mask, and cough etiquette compared with uncovered coughing (P 

The coronavirus disease 2019 (COVID-19) pandemic has caused untold disruption throughout the world. Understanding the mechanisms for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is key to preventing further spread, but there is confusion over the meaning of ?airborne? whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago which has generated mythological beliefs that obscure current thinking. This article collates and The coronavirus disease 2019 (COVID-19) pandemic has caused untold disruption throughout the world. Understanding the mechanisms for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is key to preventing further spread, but there is confusion over the meaning of 'airborne' whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago which has generated mythological beliefs that obscure current thinking. This article collates and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six 'myths' are presented, explained and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to produce this review to consolidate the evidence for airborne transmission mechanisms, and offer justification for modern strategies for prevention and control of COVID-19 in health care and the community. (c) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The Delta variant of SARS-CoV-2 causes higher viral loads in infected hosts, increasing the risk of close proximity airborne transmission through breathing, speaking and coughing. We performed a Monte Carlo simulation using a social contact network and exponential dose-response model to quantify the close proximity reproduction number of both wild-type SARS-CoV-2 and the Delta variant. We estimate more than twice as many Delta variant cases will reproduce infection in their close proximity contacts (64%) versus the wild-type SARS-CoV-2 (29%). Occupational health guidelines must consider close proximity airborne transmission and recommend improved personal respiratory protection for high-risk workers. [Display omitted] •Close proximity airborne transmission may predominate for SARS-CoV-2.•A majority of Delta variant cases will infect someone else, unlike wild-type virus.•The Delta variant overdispersion parameter (k) and R0 are consistent with smallpox.•Room-scale airborne transmission is a significant factor and requires mitigation.•Workers in close proximity to COVID-19 cases require fit-tested respirators.

There is a significant lack of scientific knowledge on population exposure to ultrafine particles (UFP) in China to date. This paper quantifies and characterises school children's personal UFP exposure and exposure intensity against their indoor and outdoor activities during a school day (home, school and commuting) in the city of Heshan within the Pearl River Delta (PRD) region, southern China. Time-series of UFP number concentrations and average size were measured over 24 h for 24 children (9–13 years old), using personal monitors over two weeks in April 2016. Time-activity diaries and a questionnaire on the general home environment and potential sources of particles at home were also collected for each participating child. The analysis included concurrently measured size distributions of ambient UFP at a nearby fixed reference site (Heshan Supersite). Hourly average UFP concentrations exhibited three peaks in the morning, midday and evening. Time spent indoors at home was found to have the highest average exposure (1.26 × 104 cm−3 during sleeping) and exposure intensity (2.41). While there is always infiltration of outdoor particles indoors (from nearby traffic and general urban background sources), indoor exposure at home was significantly higher than outdoor exposure. Based on the collected questionnaire data, this was considered to be driven predominantly by adults smoking and the use of mosquito repellent incense during the night. Outdoor activities at school were associated with the lowest average exposure (6.87 × 102 cm−3) and exposure intensity (0.52). Despite the small sample size, this study characterised, for the first time, children's personal UFP exposure in a city downwind of major pollution sources of the PRD region in China. Particularly, the results highlighted the impact of smoking at home on children's exposure. While the study could not apportion the specific contributions of second hand-smoking and mosquito coil burning, considering the prevalence of smokers among the parents who smoke at home, smoking is a very significant factor. Exposure to second-hand smoke is avoidable, and these findings point out to the crucial role of government authorities and public health educators in engaging with the community on the role of air quality on health, and the severity of the impact of second-hand smoke on children's health. •Epidemiological studies do not account for indoor UFP exposures.•Children's highest exposure and exposure intensity in Heshan were during time spent indoors at home.•Main indoor sources of UFP at home in Heshan were smoking and use of mosquito repellent incense.•The results highlighted the impact of smoking at home on children's exposure.

Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and β-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes – Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 μm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. A 0.1-unit increase in NDVI500 m and SAVI500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82–0.94) and 0.80 (0.72–0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher β-cell function. Air pollution and body mass index significantly mediated 6.9–51.1% and 8.6–78.7% these associations, respectively, while no mediation role was observed for physical activity. Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic β-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

Air pollution is among the top risk faced by people around the world, and therefore combating it is among the top priorities. It begins with identifying the sources that contribute the most to local air pollution to prioritize their control. There are advanced methods for source identification and apportionment, but such methods are not available in many low-income countries and not everywhere in all high-income countries. We propose a simplified method by using source the signatures to help obtain information about the local source contribution if no other methods are available. Using low-cost monitors, particle mass (PM2.5) and carbon monoxide (CO) concentrations were measured and the ratio of CO/PM2.5 was determined. We investigated outdoor and indoor sources, including vehicular exhaust, combustion of biomass, incense and mosquito coil burning, and cigarette smoking. The results show that the ratios differed significantly between certain pollutant sources. Compressed natural gas (CNG) engines have a high ratio (mean value of 972 +/- 419), which is attributed to relatively low PM2.5 emissions, while ship emissions and cigarette smoke recorded a relatively low ratio. Most traffic emissions recorded higher ratios than those of bushfire emissions, and ratios of most outdoor pollutant sources were much higher than those of indoor pollutant sources. There is a clear trend for ratios to decrease from high to low for CNG, petrol, diesel for buses, and fuel for ships. Our results suggest that the ratio of CO/PM2.5 can be used as an effective method to identify pollution sources.

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health -related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.  Methods We measured progress on 41 health-related S DG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2.5th percentile and 100 as the 97.5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.  Findings The global median health-related SDG index in 2017 was 59.4 (IQR 35.4-67.3), ranging from a low of 11.6 (95% uncertainty interval 9.6-14.0) to a high of 84.9 (83.1-86.7). SDG index values in countries assessed at the subnational level varied substantially particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attaimnent by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.  Interpretation The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains curative interventions in the case of NCDs towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the S DGs. What is clear is that our actions or inaction today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. 

It is known that ultrafine particles (UFP, particles smaller than 0.1 μm) can penetrate deep into the lungs and potentially have adverse health effects. However, epidemiological data on the health effects of UFP is limited. Therefore, our objective was to test the hypothesis that exposure to UFPs is associated with respiratory health status and systemic inflammation among children aged 8 to 11 years. We conducted a cross-sectional study among 655 children (43.3% male) attending 25 primary (elementary) schools in the Brisbane Metropolitan Area, Australia. Ultrafine particle number concentration (PNC) was measured at each school and modelled at homes using Land Use Regression to derive exposure estimates. Health outcomes were respiratory symptoms and diagnoses, measured by parent-completed questionnaire, spirometric lung function, exhaled nitric oxide (FeNO), and serum C reactive protein (CRP). Exposure-response models, adjusted for potential personal and environmental confounders measured at the individual, home and school level, were fitted using Bayesian methods. PNC was not independently associated with respiratory symptoms, asthma diagnosis or spirometric lung function. However, PNC was positively associated with an increase in CRP (1.188-fold change per 1000 UFP cm−3 day/day (95% credible interval 1.077 to 1.299)) and an increase in FeNO among atopic participants (1.054 fold change per 1000 UFP cm−3 day/day (95% CrI 1.005 to 1.106)). UFPs do not affect respiratory health outcomes in children but do have systemic effects, detected here in the form of a positive association with a biomarker for systemic inflammation. This is consistent with the known propensity of UFPs to penetrate deep into the lung and circulatory system. •Epidemiological evidence on ultrafine particles (UFP) and human health is limited.•Only a handful of studies investigating the health impact of UFP in children.•We conducted a cross-sectional study among 655 children from 25 primary schools.•UFP do not affect respiratory health in children but do have systematic effects.•We showed a positive association with a biomarker for systemic inflammation.

Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019.8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric.The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019.Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring.Bill & Melinda Gates Foundation.

Quantitative information on indoor temperature is important for understanding the impacts of temperature on building energy consumption, human health and comfort, however, such information is scarce. Additionally, extraction of useful information from existing indoor temperature data is hindered by varying study designs. The study aims to: simultaneously monitor indoor and outdoor temperature of selected houses and to develop a model describing their relationship; and analyse the strengths and limitations of the model towards understanding the association between indoor and outdoor temperature. Temperature sensors were installed in 15 houses in Brisbane, Australia, to monitor at intervals of 30 min over the winter of 2016. The linear mixed-effects model which we developed performed well and predicted that on average, 1°C increase in outdoor temperature resulted in an increase of 0.4°C ± 0.05°C in indoor temperature. While the sample size of the study is relatively small, our model is expected to perform with any sample sizes particularly with large sample. Application of our indoor/outdoor temperature modelling will facilitate understanding the influence of temperature on energy consumption in households and human health. Such information is imperative towards future comfortable and low energy homes.

Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across a groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used dinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4 B97.6, 109-115.8, J16 J16.9, J20-121.9, J91.0, P23.0 P23.4, and U04 U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23109 site-years of vital r *stration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian metaregression tool, to analyse age sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and daims and inpatient data. Additio y, we estimated age sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1.30 million (95% UI 1.18-1.42) male deaths and 1.20 million (1.07-1.33) female deaths. Age-standardised incidence and mortality rates were 1.17 times (95% UI 1.16-1.18) and 1.31 times (95% UI 1.23-1.41) greater in males than in fe es in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126.0% [95% UI 121.4-131.1]) and deaths (100.0% [83.4-115.9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest dedine was observed for LRI deaths in males younger than 5 years (-70.7% [-77.2 to 61.8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53.0% [95% UI 37.7-61.8] in males and 56.4% [40.7-65.1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26.0% [95% UI 16.6-35.5] for males and PAF 25.8% [16.3-35.4] for females). PAFs of male LRI deaths attributed to smoking were 20.4% (95% UI 15.4-25.2) in those aged 15-49 years, 305% (24.1-36. 9) in those aged 50-69 years, and 21.9% (16. 8-27. 3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21.1% (95% UI 14.5-27.9) in those aged 15-49 years and 18 " 2% (12.5-24.5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11-7% (95% UI 8.2-15.8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children you - than 5 years was dearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, induding promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Copyright 2022 The Author(s). Published by Elsevier Ltd.

The study aimed to identify diurnal indoor temperature patterns and quantify the impact of outdoor on indoor temperature as well as of other modifying factors. Indoor and outdoor temperatures of 77 houses in Brisbane, Australia were monitored with temperature sensors for one year (May 2017-2018). A linear mixed effect model predicted that on average, a 1 degrees C increase in outdoor temperature resulted in a 0.41 degrees C increase in indoor temperature during both the cool and warm seasons. The age of the house, building material, roof material and insulation had a moderate influence on indoor temperature. Queenslander houses (a stand-alone timber structure mounted on stumps with an extensive veranda) were, in general, cooler (0.5 degrees C cooler in winter) and reactive (meaning, having a strong association with the outdoor temperature), while slab-on-ground houses were, in general, warmer (0.3 degrees C) and stable (meaning, having less association with the outdoor temperature). From the indoor temperature patterns identified for the heated and cooled houses it was concluded that in this climate, heating and cooling is seldom done for 24 h. This quantitative information is crucial for understanding the influence of temperature on human health and household energy consumption at the time when climate change mitigation approaches are being discussed. (C) 2019 Elsevier B.V. All rights reserved.

Air quality is often assessed using particulate matter (PM) mass concentration without considering its toxicity, thus possibly leading to improper control policies or inadequate health protection. Here, we studied differences in oxidative potentials (OPs) of PM samples collected using automobile air conditioning (AC) filters from 19 global cities, as well as influences from microbial contents. Dithiothreitol (DTT) assay showed remarkable differences in the PM OPs among cities (p-values ≤ 0.001, Kruskal-Wallis test). For example, the normalized index of oxidant generation (NIOG) of PM samples in San Francisco (2.20 × 10−2, annual average PM10 = 16 μg/m3) was found to be twice that in Beijing (1.14 × 10−2, annual average PM10 = 135 μg/m3). Limulus amebocyte lysate (LAL) assay found that PM-borne endotoxin ranged from 12.16 EU/mg (Florianopolis, Brazil) to 2518.23 EU/mg (Chennai, India) among cities. Besides, culturing method and real-time qPCR revealed significant differences of up to ∼100-fold in both bacterial and fungal levels among 19 cities. Spearman's correlation analysis implied that PM-borne microbes such as bacteria and fungi as well as metals could strongly influence the PM OP. As an example, our results in Xi'an, China further suggest that the PM2.5 OP evolves for a particular city over the time, which is attributable to both the urbanization and air pollution control measures. This work highlights the importance in optimizing the current air quality control measures by considering the toxicity factor and its microbial constituents. [Display omitted] •Ambient PM toxicity per unit of mass was shown to vary greatly with different cities across the world.•PM-borne biologicals were shown to exhibit remarkable differences across major cities, contributing to the difference of PM toxicity.•PM toxicity was shown to evolve over the time as a result of ground human activities as well as air pollution control measures.•This work highlights the need of taking into account of PM toxicity for future air pollution control efforts.

Filters in residential and office air conditioning (A/C) systems have been used as sampling devices for monitoring different pollutants. However, cabin air filters (CAFs) in the A/C system of passenger cars have not been utilised for this purpose. In this study, we collected 22 used CAFs from passenger cars in Hanoi, Vietnam to analyse for 8 polybrominated diphenyl ethers (PBDEs) and 10 organophosphate esters (OPEs). All the analytes were detected in more than 50% of samples with the exception of BDE153 and BDE154. The average concentrations of ∑10OPEs and ∑8BDEs in the captured dust were 2600 and 40 ng/g, respectively with Tris (1-chloro-2-propyl) phosphate (TCIPP) and BDE209 as the dominant congener in OPE and BDE groups, respectively. CAFs are a potential tool to qualitatively assess the levels of semi-volatile chemicals in suspended dust in cars as a screening step for exposure assessment of those chemicals. [Display omitted]

•Few studies have examined association between greenness and metabolic syndrome.•We explored the topic in 15,477 Chinese urban dwellers.•Higher greenness levels were associated with lower odds of metabolic syndrome.•Stronger association was observed in people aged 65 years or younger and those with higher household income.•Air pollution partly mediated the greenness-metabolic syndrome association. Residing in greener areas has several health benefits, but no study to date has examined the effects of greenness on metabolic syndrome (MetS). We aimed to assess associations between residential greenness and MetS prevalence in China, and to explore whether air pollution and physical activity mediated any observed associations. We analyzed data from 15,477 adults who participated in the 33 Communities Chinese Health Study during 2009. We defined MetS according to standard guidelines for Chinese populations. Residential greenness was estimated using the Normalized Difference Vegetation Index (NDVI), the Soil Adjusted Vegetation Index (SAVI), and the Vegetation Continuous Field (VCF). We used generalized linear mixed models to assess the associations between greenness and MetS, and mediation analyses to explore potential mechanisms underlying the associations. Higher greenness levels were associated with lower odds of MetS [e.g., for every interquartile range increase of NDVI500-m, SAVI500-m, and VCF500-m, the adjusted odds ratio of MetS was 0.81 (95% confidence interval: 0.70–0.93), 0.80 (95% confidence interval: 0.69–0.93), and 0.91 (95% confidence interval: 0.83–1.00), respectively]. The direction and the magnitude of the associations persisted in several sensitivity analyses. Stratified analyses showed that age and household income modified the associations, with greater effect estimates observed in participants younger than 65 years old or those with higher household income. Particulate matter with an aerodynamic diameter ≤10 μm, nitrogen dioxide, and ozone mediated 2.1–20.3% of the associations between greenness and MetS; no evidence of mediation was observed for physical activity. Our findings suggest a beneficial association for residential greenness and MetS in Chinese urban dwellers, especially for participants younger than 65 years old and those with higher household income. Particulate matter with an aerodynamic diameter ≤10 μm, nitrogen dioxide and ozone, but not physical activity, may only partially mediate the association.

Given the widespread concern but general lack of information over the possibility of SARS-CoV-2 infection in public transport, key issues such as passenger personal hygiene, efficient air circulation systems, and the effective disinfection of frequently touched surfaces need to be evaluated to educate the public and diminish the risk of viral transmission as we learn to live with the ongoing pandemic. In this context we report on a study involving the collection of 99 samples taken from inside Barcelona buses and subway trains in May to July 2020. From this sample group 82 (58 surface swabs, 9 air conditioning (a/c) filters, 3 a/c dust, 12 ambient air) were selected to be analysed by RT-PCR for traces of the SARS-CoV-2 virus. Thirty of these selected samples showed evidence for one or more of 3 target RNA gene regions specific for this virus (IP2, IP4, E). Most (24) of these 30 samples showed positivity for only 1 of the 3 RNA targets, 4 samples yielded 2 targets, and 2 samples provided evidence for all 3 targets. RNA remnants were more common in surface swabs from support bars (23 out of 58) than in ambient air inside the vehicles (3 out of 12), with relatively higher concentrations of viral RNA fragments in buses rather than in trains. Whereas subway train a/c filters examined were all virus-free, 4 of the 9 bus a/c filter/dust samples yielded evidence for viral RNA. After nocturnal maintenance and cleaning most buses initially yielding positive results subsequently showed elimination of the RT-PCR signal, although signs of viral RNA remained in 4 of 13 initially positive samples. The presence of such remnant viral traces however does not demonstrate infectivity, which in the present study is considered unlikely given the fragmentary nature of the gene targets detected. Nevertheless, best practice demands that close attention to ventilation systems and regular vehicle disinfection in public transport worldwide need to be rigorously applied to be effective at eliminating traces of the virus throughout the vehicle, especially at times when COVID-19 cases are peaking. Additionally, infectivity tests should be implemented to evaluate the efficiency of disinfection procedures to complement the information resulting from RT-PCR analysis. Modelling the probability of infection whilst travelling in buses under different scenarios indicates that forced ventilation greatly reduces the risk.

Understanding spatiotemporal variation of PM1 (mass concentrations of particles with aerodynamic diameter 

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Background Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)-a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010-19 period. Findings Globally, there were 2.26 million (95% uncertainty interval 2.07 to 2.45) new cases of tracheal, bronchus, and lung cancer, and 2.04 million (1.88 to 2.19) deaths and 45.9 million (42.3 to 49.3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3.26 million (3.03 to 3.51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23.3% (12.9 to 33.6) globally and the number of larynx cancer cases increased by 24.7% (16.0 to 34.1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7.4% (-16.8 to 1.6) and age-standardised incidence rates of larynx cancer decreased by 3.0% (-10.5 to 5.0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0.9% (-8.2 to 10.2) for tracheal, bronchus, and lung cancer and decreased by 0.5% (-8.4 to 8.1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64.2% (61.9-66.4) of all deaths from tracheal, bronchus, and lung cancer and 63.4% (56.3-69.3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. Interpretation The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations-namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

Although the interpersonal distance represents an important parameter affecting the risk of infection due to respiratory viruses, the mechanism of exposure to exhaled droplets remains insufficiently characterized. In this study, an integrated risk assessment is presented for SARS-CoV-2 close proximity exposure between a speaking infectious subject and a susceptible subject. It is based on a three-dimensional transient numerical model for the description of exhaled droplet spread once emitted by a speaking person, coupled with a recently proposed SARS-CoV-2 emission approach. Particle image velocimetry measurements were conducted to validate the numerical model. The contribution of the large droplets to the risk is barely noticeable only for distances well below 0.6 m, whereas it drops to zero for greater distances where it depends only on airborne droplets. In particular, for short exposures (10 s) a minimum safety distance of 0.75 m should be maintained to lower the risk below 0.1%; for exposures of 1 and 15 min this distance increases to about 1.1 and 1.5 m, respectively. Based on the interpersonal distances across countries reported as a function of interacting individuals, cultural differences, and environmental and sociopsychological factors, the approach presented here revealed that, in addition to intimate and personal distances, particular attention must be paid to exposures longer than 1 min within social distances (of about 1 m). (C) 2021 Elsevier B.V. All rights reserved.

Electronic cigarette uses propylene glycol and glycerol to deliver nicotine and flavors to the lungs. Given the hundreds of different brands, the thousands of flavors available and the variations in nicotine concentrations, it is likely that electronic cigarette settings and e‐liquid composition affect the size distribution of particles emitted and ultimately pulmonary deposition. We used the inExpose e‐cigarette extension to study two separate modes of operation of electronic cigarettes, namely power‐controlled and the temperature‐controlled. We also assessed several e‐liquids based on propylene glycol and glycerol concentrations, nicotine content, and selected monomolecular flavoring agents (menthol, vanillin, and maltol). Particle size distribution was measured using a Condensation Particle Counter and a Scanning Mobility Particle Sizer spectrometer. Lung deposition was predicted using the International Commission on Radiological Protection model. For all resistance coils, increase in power delivery generated larger particles while maintaining a higher coil temperature generated smaller particles. Increase in glycerol concentration led to the generation of larger particles. With regard to flavors, we showed that despite minor effect of menthol and maltol, vanillin dramatically increased particle size. Presence of nicotine also increased particle size. Finally, particles emitted by the electronic cigarette were predicted to mainly deposit in the alveoli and conditions generating larger particle sizes led to a reduction in predicted lung deposition. This study shows that coil temperature, propylene glycol and glycerol concentrations, presence of nicotine, and flavors affect the size of particles emitted by an electronic cigarette, directly affecting predicted lung deposition of these particles.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

The real-time monitoring of reductions of economic activity by containment measures and its effect on the transmission of the coronavirus (COVID-19) is a critical unanswered question. We inferred 5,642 weekly activity anomalies from the meteorology-adjusted differences in spaceborne tropospheric NO column concentrations after the 2020 COVID-19 outbreak relative to the baseline from 2016 to 2019. Two satellite observations reveal reincreasing economic activity associated with lifting control measures that comes together with accelerating COVID-19 cases before the winter of 2020/2021. Application of the near-real-time satellite NO observations produces a much better prediction of the deceleration of COVID-19 cases than applying the Oxford Government Response Tracker, the Public Health and Social Measures, or human mobility data as alternative predictors. A convergent cross-mapping suggests that economic activity reduction inferred from NO is a driver of case deceleration in most of the territories. This effect, however, is not linear, while further activity reductions were associated with weaker deceleration. Over the winter of 2020/2021, nearly 1 million daily COVID-19 cases could have been avoided by optimizing the timing and strength of activity reduction relative to a scenario based on the real distribution. Our study shows how satellite observations can provide surrogate data for activity reduction during the COVID-19 pandemic and monitor the effectiveness of containment to the pandemic before vaccines become widely available.

Concerns about air quality were expressed in preparations for the Commonwealth Games (Games), which were held at the Gold Coast, Australia, from 4th to 15th April, 2018, an international sporting event attended by more than 6600 athletes and over 670,000 visitors. Our aim was to trial application of low-cost sensors by conducting high spatial resolution air quality monitoring. An additional aim was to determine any impacts of the Games, and to involve in the process the relevant stakeholders. A network of 9 KOALA monitors measuring PM2.5 and carbon monoxide (CO), supported by one set of reference instruments and a meteorological station, were deployed for a 6 week period across a suburb hosting most of the Games activities. Due to community interest, a scaled down version of 3 monitors and a reference instrument operates to this date. We showed that the concentrations of both PM2.5 and CO were low during the Games (4 μg/m3 and 0.112 ppm respectively), and that the Games did not result in deterioration of air quality. We demonstrated that the involvement of the stakeholders including the local authorities, the community and a high school resulted in an increased awareness of the importance of air quality monitoring, and elevated interest of the students in science of the environment. There was a high correlation between daily averages of PM2.5 measured by the monitors and the reference instrument (R2 = 0.89) over a 12 month period, which supports low cost monitors as a viable option for long term air quality monitoring. [Display omitted] •Versatile new device employed for real-time PM2.5 and CO monitoring•Low-cost air quality monitoring network at 2018 Commonwealth Games•High correlation with reference instrumentation•Successfully determined temporal and spatial variability of air quality

Incense burning is a common cultural and religious practice in many Asian countries, including Vietnam. However, there is scarce information about the impact of incense burning in the residential indoor environment. In this study, we quantified the concentrations of PM2.5 indoor and outdoor and assessed the influence of incense burning on indoor air quality at residential houses in Hanoi, Vietnam. Three AirVisual Pro monitors were used to simultaneously and continuously measure PM2.5 concentrations, both indoor and outdoor for one week at each of 32 urban residential homes. Over 47 % of the homes had a daily average indoor PM2.5 concentration greater than 50 μg/m3, the recommended guideline in Vietnam. The daily average indoor PM2.5 concentration in the homes was 52.1 ± 33.9 μg/m3, while the corresponding outdoor concentration was 54.4 ± 37.6 μg/m3. These values were significantly higher in homes that burnt incense, with mean concentrations in a room during an incense burning event being 201.3 ± 132.2 μg/m3 with a 1 min-average peak of 825.5 μg/m3. Multiple linear regression analysis showed that, incense burning increased the geometric mean of indoor PM2.5 concentration by 120 %, after adjusting for other factors. Our results indicated the need for raising public awareness on the impact of incense burning on air quality in household environments. •First study quantified the impact of incense burning on indoor air quality in Vietnam.•Indoor PM2.5 levels indoor are strongly influenced by incense burning and exceed standards.•PM2.5 levels in places where incense used frequently were >3 times higher than other places.•Incense burning could increase indoor PM2.5 concentration by up to 120 %.

Much research has been conducted to find evidence of the environmental Kuznets curve (EKC) in the relationship between air-pollutant concentration and economic development. A major focus of EKC-related research has so far been to identify the turning point illustrated by EKC theory or to predict the moment when the turning point will occur. In our research, via analyzing the relationship between an aggregate social-development-representative variable (the Socio-demographic Index or SDI) and the population-weighted concentration of PM , we propose that the overall relationship takes the form of a tilted-S shape with two types of turning points rather than one. Additionally, our research shows that the EKC is highly country-specific, making it extremely difficult to predict the positions of both turning points based on the historical development or trajectories of other countries. Therefore, we conclude that EKC theory is not a useful tool to predict the location of the turning points. However, for short-term prediction of the relationship, we advocate the use of support vector regression, which can forecast the evolution, unless rapid changes are occurring. We suggest that policy makers should not anchor their hopes on predicting turning points from previous studies, but should put more effort into dealing with present particulate matter pollution.

Despite its emerging significant public health concern, the presence of antibiotic resistance genes (ARGs) in urban air has not received significant attention. Here, we profiled relative abundances (as a fraction, normalized by 16S rRNA gene) of 30 ARG subtypes resistant to seven common classes of antibiotics, which are quinolones, beta-lactams, macrolides, tetracyclines, sulfonamides, aminoglycosides, and vancomycins, in ambient total particulate matter (PM) using a novel protocol across 19 world cities. In addition, their longitudinal changes in PM2.5 samples in Xi'an, China as an example were also studied. Geographically, the ARGs were detected to vary by nearly 100-fold in their abundances, for example, from 0.07 (Bandung, Indonesia) to 5.6 (San Francisco, USA). The beta-lactam resistance gene blaTEM was found to be most abundant, seconded by quinolone resistance gene qepA; and their corresponding relative abundances have increased by 178% and 26%, respectively, from 2004 to 2014 in Xi'an. Independent of cities, gene network analysis indicates that airborne ARGs were differentially contributed by bacterial taxa. Results here reveal that urban air is being polluted by ARGs, and different cities are challenged with varying health risks associated with airborne ARG exposure. This work highlights the threat of urban airborne transmission of ARGs and the need of redefining our current air quality standards in terms with public health.

Particulate matter (PM) exposure is associated to the adverse change in blood lipids. Vitamin D is beneficial to lipid metabolism, but whether vitamin D levels modifies the impact of air pollutants on lipids is unclear. The purpose of the study was to investigate if vitamin D modifies the associations of PM and serum lipids in young healthy people. From December 2017 to January 2018, a panel study with five once weekly follow-ups was conducted on 88 healthy adults aged 21.09 (1.08) (mean (SD)) years on average in Guangzhou, China. We measured serum lipids, serum 25-hydroxyvitamin D (25(OH)D) concentrations (440 blood samples in total), mass concentrations of particulate matter with diameters ≤2.5 μm (PM2.5), ≤1.0 μm (PM1.0), and ≤0.5 μm (PM0.5), and number concentrations of particulate matter with diameters ≤0.2 μm (PN0.2) and ≤0.1 μm (PN0.1) at each follow-up. Linear mixed-effect models were applied to assess the interaction of vitamin D and size-fractionated PM short-term exposure on four lipid metrics. We found the interactions between 25(OH)D and size-fractionated PM exposure on blood lipids in different lags (lag 3 days and 4 days). An interquartile range increase in PM2.5, PM1.0, PM0.5 were significantly associated with increments of 12.30%, 12.99%, and 13.66% in triglycerides (TGs) at lag 4 days at vitamin D levels

Aim: There is growing interest in the health effects following exposure to ambient particles with a diameter

Given that breathing is one of the most fundamental physiological functions, there is an urgent need to broaden our understanding of the fluid dynamics that governs it. There would be many benefits from doing so, including a better assessment of respiratory health, a basis for more precise delivery of pharmaceutical drugs for treatment, and the understanding and potential minimization of respiratory infection transmission. We review the physics of particle generation in the respiratory tract, the fate of these particles in the air on exhalation and the physics of particle inhalation. The main focus is on evidence from experimental studies. We conclude that although there is qualitative understanding of the generation of particles in the respiratory tract, a basic quantitative knowledge of the characteristics of the particles emitted during respiratory activities and their fate after emission, and a theoretical understanding of particle deposition during inhalation, nevertheless the general understanding of the entire process is rudimentary, and many open questions remain. In this Perspective on the physics of particle generation in the respiratory tract, fate in the air upon exhalation and the physics of inhalation, the authors conclude that the general understanding of the entire process is rudimentary, and many open questions remain.

Ambient particle number concentration (PNC) varies significantly in time and space within cities, yet complexity and cost prohibit large-scale routine monitoring; as a consequence, there is not enough data for assessment of human exposure to, or risk from the particles. The quality of assessments can be augmented by modelling; however, models are generally less capable of predicting PNC spatial variation than predicting variations in other ambient pollutants. To advance modelling of PNC, we aimed to develop and compare the performance of parametric and non-parametric machine learning land-use regression (LUR) models to predict hourly average PNC. We used data from 25 short-term stationary campaigns and five long-term sites during 2009-2012 in the Brisbane Metropolitan Area, Australia. We analysed three particle size ranges of total PNC (

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

The world’s population is shifting to the cities, and consequently, cities worldwide are growing in number and in size. Cities are complex systems, making it extremely difficult to build and run cities in a way that all the elements of the system operate in harmony. Recently a concept of urbanome, the genome of the city was proposed to address this complexity. Here we first explore this concept and analogy, taking advantage of the potential of other ‘omics, modern data collection techniques, Big Data analysis methods and a transdisciplinary approach. Then, we propose a theoretical approach to build the urbanome as a means of quantifying and qualifying population outcomes, being a function of the form of an urban area including the built environment, the physical and social services it provides, and the population density.

We examined the trade-offs between in-car aerosol concentrations, ventilation and respiratory infection transmission under three ventilation settings: windows open (WO); windows closed with air-conditioning on ambient air mode (WC-AA); and windows closed with air-conditioning on recirculation (WC-RC). Forty-five runs, covering a total of 324 km distance on a 7.2-km looped route, were carried out three times a day (morning, afternoon, evening) to monitor aerosols (PM2.5; particulate matter WC-AA>WC-RC) due to the ingress of polluted outdoor air on urban routes. A clear trade-off, therefore, exists for the in-car air quality (icAQ) versus ventilation, where WC-RC showed the least aerosol concentrations (i.e. four-times lower compared with WO), but corresponded to elevated CO2 levels (i.e. five-times higher compared with WO) in 20 mins. We considered COVID-19 as an example of respiratory infection transmission. The probability of its transmission from an infected occupant in a five-seater car was estimated during different quanta generation rates (2-60.5 quanta hr-1) using the Wells-Riley model. In WO, the probability with 50%-efficient and without facemasks under normal speaking (9.4 quanta hr-1) varied only by upto 0.5%. It increased by 2-fold in WC-AA (

Severe episodic air pollution blankets entire cities and regions and have a profound impact on humans and their activities. We compiled daily fine particle (PM2.5) data from 100 cities in five continents, investigated the trends of number, frequency, and duration of pollution episodes, and compared these with the baseline trend in air pollution. We showed that the factors contributing to these events are complex; however, long-term measures to abate emissions from all anthropogenic sources at all times is also the most efficient way to reduce the occurrence of severe air pollution events. In the short term, accurate forecasting systems of such events based on the meteorological conditions favouring their occurrence, together with effective emergency mitigation of anthropogenic sources, may lessen their magnitude and/or duration. However, there is no clear way of preventing events caused by natural sources affected by climate change, such as wildfires and desert dust outbreaks.

Street canyons are generally highly polluted urban environments due to high traffic emissions and impeded dispersion. Green infrastructure (GI) is one potential passive control system for air pollution in street canyons, yet optimum GI design is currently unclear. This review consolidates findings from previous research on GI in street canyons and assesses the suitability of different GI forms in terms of local air quality improvement. Studies on the effects of various GI options (trees, hedges, green walls, green screens and green roofs) are critically evaluated, findings are synthesised, and possible recommendations are summarised. In addition, various measurement methods used for quantifying the effectiveness of street greening for air pollution reduction are analysed. Finally, we explore the findings of studies that have compared plant species for pollution mitigation. We conclude that the influences of different GI options on air quality in street canyons depend on street canyon geometry, meteorological conditions and vegetation characteristics. Green walls, green screens and green roofs are potentially viable GI options in existing street canyons, where there is typically a lack of available planting space. Particle deposition to leaves is usually quantified by leaf washing experiments or by microscopy imaging techniques, the latter of which indicates size distribution and is more accurate. The pollutant reduction capacity of a plant species largely depends on its macromorphology in relation to the physical environment. Certain micromorphological leaf traits also positively correlate with deposition, including grooves, ridges, trichomes, stomatal density and epicuticular wax amount. The complexity of street canyon environments and the limited number of previous studies on novel forms of GI in street canyons mean that offering specific recommendations is currently unfeasible. This review highlights a need for further research, particularly on green walls and green screens, to substantiate their efficacy and investigate technical considerations.

Atmospheric nanoparticles are a pollutant currently unregulated through ambient air quality standards. The aim of this chapter is to assess the environmental and health impacts of atmospheric nanoparticles in European environments. This chapter begins with the conventional information on the origin of atmospheric nanoparticles, followed by their physical and chemical characteristics. A brief overview of recently published review articles on this topic is then presented to guide those readers interested in exploring any specific aspect of nanoparticles in greater detail. A further section reports a summary of recently published studies on atmospheric nanoparticles in European cities. This covers a total of about 45 sampling locations in 30 different cities within 15 European countries for quantifying levels of roadside and urban background particle number concentrations (PNCs). Average PNCs at the reviewed roadside and urban background sites were found to be 3.82 ± 3.25 × 10 4 and 1.63 ± 0.82 × 10 4 cm −3 , respectively, giving a roadside to background PNC ratio of ~2.4. Engineered nanoparticles are one of the key emerging categories of airborne nanoparticles, especially for the indoor environments. Their ambient concentrations may increase in future due to widespread use of nanotechnology integrated products. Evaluation of their sources and probable impacts on air quality and human health are briefly discussed in the following section. Respiratory deposition doses received by the public exposed to roadside PNCs in numerous European locations are then estimated. These were found to be in the 1.17–7.56 × 10 10 h −1 range over the studied roadside European locations. The following section discusses the potential framework for airborne nanoparticle regulations in Europe and, in addition, the existing control measures to limit nanoparticle emissions at source. The chapter finally concludes with a synthesis of the topic areas covered and highlights important areas for further work.

Human civilization is currently facing two particular challenges: population growth with a strong trend towards urbanization and climate change. The latter is now no longer seriously questioned. The primary concern is to limit anthropogenic climate change and to adapt our societies to its effects. Schools are a key part of the structure of our societies. If future generations are to take control of the manifold global problems, we have to offer our children the best possible infrastructure for their education: not only in terms of the didactic concepts, but also with regard to the climatic conditions in the school environment. Between the ages of 6 and 19, children spend up to 8 h a day in classrooms. The conditions are, however, often inacceptable and regardless of the geographic situation, all the current studies report similar problems: classrooms being too small for the high number of school children, poor ventilation concepts, considerable outdoor air pollution and strong sources of indoor air pollution. There have been discussions about a beneficial and healthy air quality in classrooms for many years now and in recent years extensive studies have been carried out worldwide. The problems have been clearly outlined on a scientific level and there are prudent and feasible concepts to improve the situation. The growing number of publications also highlights the importance of this subject. High carbon dioxide concentrations in classrooms, which indicate poor ventilation conditions, and the increasing particle matter in urban outdoor air have, in particular, been identified as primary causes of poor indoor air quality in schools. Despite this, the conditions in most schools continue to be in need of improvement. There are many reasons for this. In some cases, the local administrative bodies do not have the budgets required to address such concerns, in other cases regulations and laws stand in contradiction to the demands for better indoor air quality, and sometimes the problems are simply ignored. This review summarizes the current results and knowledge gained from the scientific literature on air quality in classrooms. Possible scenarios for the future are discussed and guideline values proposed which can serve to help authorities, government organizations and commissions improve the situation on a global level.