The mechanism for spread of SARS-CoV-2 has been attributed to large particles produced by coughing and sneezing. There is controversy whether smaller airborne particles may transport SARS-CoV-2. ...Smaller particles, particularly fine particulate matter (≤ 2.5 µm in diameter), can remain airborne for longer periods than larger particles and after inhalation will penetrate deeply into the lungs. Little is known about the size distribution and location of airborne SARS-CoV-2 RNA.
As a measure of hospital-related exposure, air samples of three particle sizes (> 10.0 µm, 10.0-2.5 µm, and ≤ 2.5 µm) were collected in a Boston, Massachusetts (USA) hospital from April to May 2020 (N = 90 size-fractionated samples). Locations included outside negative-pressure COVID-19 wards, a hospital ward not directly involved in COVID-19 patient care, and the emergency department.
SARS-CoV-2 RNA was present in 9% of samples and in all size fractions at concentrations of 5 to 51 copies m
. Locations outside COVID-19 wards had the fewest positive samples. A non-COVID-19 ward had the highest number of positive samples, likely reflecting staff congregation. The probability of a positive sample was positively associated (r = 0.95, p < 0.01) with the number of COVID-19 patients in the hospital. The number of COVID-19 patients in the hospital was positively associated (r = 0.99, p < 0.01) with the number of new daily cases in Massachusetts.
More frequent detection of positive samples in non-COVID-19 than COVID-19 hospital areas indicates effectiveness of COVID-ward hospital controls in controlling air concentrations and suggests the potential for disease spread in areas without the strictest precautions. The positive associations regarding the probability of a positive sample, COVID-19 cases in the hospital, and cases in Massachusetts suggests that hospital air sample positivity was related to community burden. SARS-CoV-2 RNA with fine particulate matter supports the possibility of airborne transmission over distances greater than six feet. The findings support guidelines that limit exposure to airborne particles including fine particles capable of longer distance transport and greater lung penetration.
Road dust particles play an important role in atmospheric pollution and are associated with adverse human health effects. Traffic emissions are a major source of particles in road dust. However, ...there has been limited information about the relationship between distance from road and traffic-related elements levels in road dust. We investigated the relationships between proximity to the nearest major roadway and trace element mass fractions in PM
10
and PM
2.5
re-suspended from the road surface, based on measurements at three different distance ranges. We found that mass fractions of Ba, Cu, Zr, Zn, Cl, Co, Cr, Ca, Ti in PM
10
road dust as well as Zr, Cu, Cl, Zn, Cr, Ti, Mn, Ca, Ni, and Fe in PM
2.5
road dust, significantly decreased with distance from major road. Most of these elements are associated with road traffic emissions, including both tailpipe and non-tailpipe emissions. The decrease rates differed among elements due to differences in local traffic contributions. The decreases for elements which are mainly associated with non-tailpipe traffic emissions (e.g., Ba, Zr) were more dramatic. Our results indicate that traffic emissions, especially non-tailpipe emissions, contribute substantially to road dust, suggesting the need for control strategies for non-tailpipe emissions.
Implications: We investigated the relationships between road proximity with trace element mass fractions in PM10 and PM2.5 re-suspended from the road surface. We observed significant decrease of traffic-related elements in PM10 and PM2.5 road dust with log distance from major road. We also found that the mass fractions for elements, which mainly come from traffic decrease more sharply compared to elements which come from both traffic and other sources. Our results indicate that traffic emissions contribute substantially to road dust, and imply that the distance to major road can be used as a proxy for ambient exposure.
Traffic-related particulate matter (PM) plays an important role in urban air pollution. However, sources of urban pollution are difficult to distinguish. This study utilises a mobile particle ...concentrator platform and statistical tools to investigate factors affecting roadway ambient coarse particle (PM10–2.5) and fine particle (PM2.5–0.2) concentrations in greater Boston, USA. Positive matrix factorization (PMF) identified six PM10–2.5 sources (exhaust, road salt, brake wear, regional pollution, road dust resuspension and tyre-road abrasion) and seven fine particle sources. The seven PM2.5–0.2 sources include the six PM10–2.5 sources and a source rich in Cr and Ni. Non- exhaust traffic-related sources together accounted for 65.6% and 29.1% of the PM10–2.5 and PM2.5–0.2 mass, respectively. While the respective contributions of exhaust sources were 10.4% and 20.7%. The biggest non-exhaust contributor in the PM10–2.5 was road dust resuspension, accounting for 29.6%, while for the PM2.5–0.2, the biggest non-exhaust source was road-tyre abrasion, accounting for 12.3%. We used stepwise general additive models (sGAMs) and found statistically significant (p < 0.05) effects of temperature, number of vehicles and rush hour periods on exhaust, brake wear, road dust resuspension and road-tyre abrasion with relative importance between 19.1 and 62.2%, 12.5–42.1% and 4.4–42.2% of the sGAM model's explained variability. Speed limit and road type were also important factors for exhaust, road-tyre and brake wear sources. Meteorological variables of wind speed and relative humidity were significantly associated with both coarse and fine road dust resuspension and had a combined relative importance of 38% and 48%. The quantifying results of the factors that influence traffic-related sources can offer key insights to policies aiming to improve near-road air quality.
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•Sources of PM10–2.5 and PM2.5–0.2 were investigated in 90 near-road environments.•Coarse and fine non-exhaust traffic-related sources combined accounted 65.6% and 29.1% respectively.•Stepwise GAM identified ambient and road factors affecting coarse and fine non-exhaust sources.•Temperature, vehicle number and rush-hours influenced all non-exhaust sources.•Road dust resuspension & road-tyre abrasion were influenced by wind speed, relative humidity and vehicle speed.
Traffic-related air pollution is associated with various adverse health effects. In the absence of more complicated exposure assessment techniques, many environmental health studies have used the ...natural logarithm of distance to road as a proxy for traffic-related exposures. However, research validating this proxy and further explaining the spatial patterns and elemental composition of traffic-related particulate matter air pollution remains limited. In this study, we collected air samples using a mobile particle concentrator that allowed for high sample loading from major roadways in the Greater Boston Area. We found that concentrations of Cl, Ti, V, Cr, Mn, Fe, Co, Cu, Zn, Sr, Zr, Sn, Ba, and Pb were significantly associated with the natural logarithm of distance to road in coarse particulate matter, and total fine particulate mass concentrations of Al, Ca, Ti, Cr, Mn, Fe, Cu, and Zn were significantly associated with natural logarithm of distance to road in fine particulate matter. Road type (A1 or A2 primary roads or highways versus A3 secondary and connecting roads) was not a significant predictor of any traffic-related elements in particulate matter air pollution. Our results help identify traffic-related elements in particulate matter air pollution and support the use of logarithm of distance to road as a proxy for traffic-related particulate matter air pollution exposure assessment in epidemiological studies.
The aim of this study was to investigate, in a well-controlled experimental environment, whether air pollution from an urban center would affect inflammatory and cardiorespiratory responses during ...prolonged moderate exercise (i.e., 90 min). Ten healthy men performed two experimental trials under filtered and polluted air, inside an environmental chamber located in Sao Paulo downtown, Brazil. Blood samples were obtained at rest, 30, 60, and 90 min of the exercise to determine the serum cytokines concentration, while arterial pressure was recorded immediately after the exercise. The serum cytokines were not altered until 60 min of exercise for both conditions (P > 0.05). Otherwise, at 90 min of exercise, the IL-6 (P = 0.047) and vascular endothelial growth factor (VEGF) (P = 0.026) were significantly higher and IL-10 tended to decrease (P = 0.061) in polluted air condition compared to filtered air condition. In addition, both systolic (P = 0.031) and diastolic (P = 0.009) arterial pressure were higher in polluted air condition than filtered air condition. These findings demonstrate that the exercise of longer duration (i.e., 90 min), but not of shorter duration (i.e., <60 min), performed in vehicular air pollution condition results in pronounced pro-inflammatory and increased arterial pressure responses.
•Effects of air pollution during exercise seem to be dependent on exercise duration.•Air pollution during long duration exercise might increase post arterial pressure.•Systemic inflammation occurs after long exercise under air pollution exposure.•Distance should be considered in active transportation under air pollution exposure.
Aerosol-borne SARS-CoV-2 has not been linked specifically to nosocomial outbreaks.
To explore the genomic concordance of SARS-CoV-2 from aerosol particles of various sizes and infected nurses and ...patients during a nosocomial outbreak of COVID-19.
This cohort study included patients and nursing staff in a US Department of Veterans Affairs inpatient hospital unit and long-term-care facility during a COVID-19 outbreak between December 27, 2020, and January 8, 2021. Outbreak contact tracing was conducted using exposure histories and screening with reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2. Size-selective particle samplers were deployed in diverse clinical areas of a multicampus health care system from November 2020 to March 2021. Viral genomic sequences from infected nurses and patients were sequenced and compared with ward nurses station aerosol samples.
SARS-CoV-2.
The primary outcome was positive RT-PCR results and genomic similarity between SARS-CoV-2 RNA in aerosols and human samples. Air samplers were used to detect SARS-CoV-2 RNA in aerosols on hospital units where health care personnel were or were not under routine surveillance for SARS-CoV-2 infection.
A total of 510 size-fractionated air particle samples were collected. Samples representing 3 size fractions (>10 μm, 2.5-10 μm, and <2.5 μm) obtained at the nurses station were positive for SARS-CoV-2 during the outbreak (3 of 30 samples 10%) and negative during 9 other collection periods. SARS-CoV-2 partial genome sequences for the smallest particle fraction were 100% identical with all 3 human samples; the remaining size fractions shared >99.9% sequence identity with the human samples. Fragments of SARS-CoV-2 RNA were detected by RT-PCR in 24 of 300 samples (8.0%) in units where health care personnel were not under surveillance and 7 of 210 samples (3.3%; P = .03) where they were under surveillance.
In this cohort study, the finding of genetically identical SARS-CoV-2 RNA fragments in aerosols obtained from a nurses station and in human samples during a nosocomial outbreak suggests that aerosols may have contributed to hospital transmission. Surveillance, along with ventilation, masking, and distancing, may reduce the introduction of community-acquired SARS-CoV-2 into aerosols on hospital wards, thereby reducing the risk of hospital transmission.
Carpal tunnel syndrome (CTS) is the most common cause of peripheral compressive neuropathy and consists of compression of the median nerve in the wrist. Although there are several etiologies, ...idiopathic is the most prevalent origin, and among the forms of treatment for CTS, conservative is the most indicated. However, despite the high prevalence in and impact of this syndrome on the healthcare system, there are still controversies regarding the best therapeutic approach for patients. Therefore, noting that some studies point to vitamin D deficiency as an independent risk factor, which increases the symptoms of the syndrome, this study evaluated the role of vitamin D supplementation and its influence on pain control, physical examination and response electroneuromyography to conservative treatment of carpal tunnel syndrome. For this, the sample consisted of 14 patients diagnosed with CTS and hypovitaminosis D, who were allocated into two groups. The control group received corticosteroid treatment, while the experimental group received corticosteroid treatment associated with vitamin D. Thus, from this study, it can be concluded that patients who received vitamin D, when compared to those who did not receive it, showed improvement in the degree of pain intensity, a reduction in symptom severity and an improvement in some electroneuromyographic parameters.
•Appropriate management of AF patients with cancer in real-world clinical practice is challenging.•In this EORP-AF study, we analyzed a cohort of AF patients with prior or active cancer.•A structured ...approach based on the “Atrial fibrillation Better Care” (ABC) Pathway is still suboptimal.•Adherence to the “C” criterion (i.e. management of comorbidities) was more critical, being specifically lower in cancer patients.•Adherence to the ABC pathway was independently associated with a lower risk outcomes.
Implementation of the Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF), but the impact of adherence to ABC pathway in patients with cancer is unknown.
To investigate the adherence to ABC pathway and its impact on adverse outcomes in AF patients with cancer.
Patients enrolled in the EORP-AF General Long-Term Registry were analyzed according to (i) No Cancer; and (ii) Prior or active cancer and stratified in relation to adherence to the ABC pathway. The composite Net Clinical Outcome (NCO) of all-cause death, major adverse cardiovascular events and major bleeding was the primary endpoint.
Among 6550 patients (median age 69 years, females 40.1%), 6005 (91.7%) had no cancer, while 545 (8.3%) had a diagnosis of active or prior cancer at baseline, with the proportions of full adherence to ABC pathway of 30.6% and 25.7%, respectively. Adherence to the ABC pathway was associated with a significantly lower occurrence of the primary outcome vs. non-adherence, both in ‘no cancer’ and ‘cancer’ patients adjusted Hazard Ratio (aHR) 0.78, 95% confidence interval (CI): 0.66–0.92 and aHR 0.59, 95% CI 0.37–0.96, respectively. Adherence to a higher number of ABC criteria was associated with a lower risk of the primary outcome, being lowest when 3 ABC criteria were fulfilled (no cancer: aHR 0.54, 95%CI: 0.36–0.81; with cancer: aHR 0.32, 95% CI 0.13–0.78).
In AF patients with cancer enrolled in the EORP-AF General Long-Term Registry, adherence to ABC pathway was sub-optimal. Full adherence to ABC-pathway was associated with a lower risk of adverse events
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Adherence to the “Atrial fibrillation Better Care” (ABC) pathway in patients with atrial fibrillation and cancer and its impact on clinical outcomes.
Bleeding is a common hemostatic disorder that occurs in
envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in
envenomations with bleeding. This is an ...observational study with
snakebite patients (
= 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (
= 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (
= 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of
envenomations with systemic bleeding due to tissue factor release.
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