Possible role of aerosol transmission in a hospital outbreak of influenza.

BACKGROUND: We examined the role of aerosol transmission of influenza in an acute ward setting. METHODS: We investigated a seasonal influenza A outbreak that occurred in our general medical ward (with open bay ward layout) in 2008. Clinical and epidemiological information was collected in real time during the outbreak. Spatiotemporal analysis was performed to estimate the infection risk among patients. Airflow measurements were conducted, and concentrations of hypothetical virus-laden aerosols at different ward locations were estimated using computational fluid dynamics modeling. RESULTS: Nine inpatients were infected with an identical strain of influenza A/H3N2 virus. With reference to the index patient's location, the attack rate was 20.0% and 22.2% in the "same" and "adjacent" bays, respectively, but 0% in the "distant" bay (P = .04). Temporally, the risk of being infected was highest on the day when noninvasive ventilation was used in the index patient; multivariate logistic regression revealed an odds ratio of 14.9 (95% confidence interval, 1.7-131.3; P = .015). A simultaneous, directional indoor airflow blown from the "same" bay toward the "adjacent" bay was found; it was inadvertently created by an unopposed air jet from a separate air purifier placed next to the index patient's bed. Computational fluid dynamics modeling revealed that the dispersal pattern of aerosols originated from the index patient coincided with the bed locations of affected patients. CONCLUSIONS: Our findings suggest a possible role of aerosol transmission of influenza in an acute ward setting. Source and engineering controls, such as avoiding aerosol generation and improving ventilation design, may warrant consideration to prevent nosocomial outbreaks.

Estimating natural-ventilation potential considering both thermal comfort and IAQ issues

Natural-ventilation potential (NVP) value can provide the designers significant information to properly design and arrange natural ventilation strategy at the preliminary or conceptual stage of ventilation and building design. Based on the previous study by Yang et al. [Investigation potential of natural driving forces for ventilation in four major cities in China. Building and Environment 2005;40:739–46], we developed a revised model to estimate the potential for natural ventilation considering both thermal comfort and IAQ issues for buildings in China. It differs from the previous one by Yang et al. in two predominant aspects: (1) indoor air temperature varies synchronously with the outdoor air temperature rather than staying at a constant value as assumed by Yang et al. This would recover the real characteristic of natural ventilation, (2) thermal comfort evaluation index is integrated into the model and thus the NVP can be more reasonably predicted. By adopting the same input parameters, the NVP values are obtained and compared with the early work of Yang et al. for a single building in four representative cities which are located in different climates, i.e., Urumqi in severe cold regions, Beijing in cold regions, Shanghai in hot summer and cold winter regions and Guangzhou in hot summer and warm winter regions of China. Our outcome shows that Guangzhou has the highest and best yearly natural-ventilation potential, followed by Shanghai, Beijing and Urumqi, which is quite distinct from that of Yang et al. From the analysis, it is clear that our model evaluates the NVP values more consistently with the outdoor climate data and thus reveals the true value of NVP.

Exposure to fine particulate matter in ten night clubs in Athens Greece: studying the effect of ventilation, cigarette smoking and resuspension

The aim of the present work is to study the occupants' exposure to fine particulate concentrations in ten nightclubs (NCs) in Athens, Greece. Measurements of PM1 and PM 2.5 were made in the outdoor and indoor environment of each NC. The average indoorPM1 andPM 2.5 concentrations were found to be 181.77 μgm−3 and 454.08 μg m−3 respectively, while the corresponding outdoor values were 11.04 μg m−3 and 32.19 μg m−3. Ventilation and resuspension rates were estimated through consecutive numerical experiments with an indoor air quality model and were found to be remarkably lower than the minimum values recommended by national standards. The relative effects of the ventilation and smoking on the occupants' exposures were examined using multiple regression techniques. Itwas found that given the low ventilation rates, the effect of smoking as well as the occupancy is of the highest importance. Numerical evaluations showed that if the ventilation rates were at the minimum values set by national standards, then the indoor exposures would be reduced at the 70% of the present exposure values.

Analysis of Direct Outdoor Air Cooling Efficency for Combined Variable Air Volume Air-conditioning System in Stores in Cold Climates of China

Direct outdoor air cooling contributes a lot not only to the improvement of the indoor air quality but also to the energy saving. Its full use will reduce the water chiller’s running time especially in some stores where cooling load keeps much higher and longer than that in other buildings. A novel air-conditioning system named Combined Variable Air Volume system (CVAV), combining a normal AHU with a separate outdoor air supply system, was proposed firstly by the authors. The most attractive feature of the system is its full utilization of cooling capacity and freshness of outdoor air in the transition period of the year round. On the basis of the obtain of the dynamic cooling loads of the typical shopping malls in different four cities located in cold climates in China with the aid of DOE-2, the possibility of increasing the amount of outdoor air volume of CVAV system in the transition period instead of operating the water chillers was confirmed. Moreover, a new concept, Direct Outdoor Air Cooling Efficiency (DOACE), was defined as the ratio of cooling capacity of outdoor air to the water chiller, indicating the degree of outdoor air’s utilization. And the DOACE of the CVAV was calculated and compared with that of conventional all-air constant volume air-conditioning systems, the results showed that CVAV bear much more energy saving potential with the 10%~19% higher DOACE and it is a kind of energy efficient systems and can improve the indoor air quality as well.

Volume-based size distribution of accumulation and coarse particles (PM0.1–10) from cooking fume during oil heating

Particulate matter generated during the cooking process has been identified as one of the major problems of indoor air quality and indoor environmental health. Reliable assessment of exposure to cooking-generated particles requires accurate information of emission characteristics especially the size distribution. This study characterizes the volume/mass-based size distribution of the fume particles at the oil-heating stage for the typical Chinese-style cooking in a laboratory kitchen. A laser-diffraction size analyzer is applied to measure the volume frequency of fume particles ranged from 0.1 to 10 μm, which contribute to most mass proportion in PM2.5 and PM10. Measurements show that particle emissions have little dependence on the types of vegetable oil used but have a close relationship with the heating temperature. It is found that volume frequency of fume particles in the range of 1.0–4.0 μm accounts for nearly 100% of PM0.1–10 with the mode diameter 2.7 μm, median diameter 2.6 μm, Sauter mean diameter 3.0 μm, DeBroukere mean diameter 3.2 μm, and distribution span 0.48. Such information on emission characteristics obtained in this study can be possibly used to improve the assessment of indoor air quality due to PM0.1–10 in the kitchen and residential flat.

Venues on the verges: London's theater government between 1594 and 1614

In 1594, major decisions were made by the governors of London and the country about plays and playing. We need to learn what lay behind these events, such as what led James Burbage to build his Blackfriars theater in 1596. That initial fiasco might tell us much about what lay behind Shakespeare’s decision to join the new Chamberlain’s Men in 1594 and his subsequent commitment to them as a full-time playwright. When the Globe burned down in 1613, a majority of the shareholders decided to rebuild it at great cost, but Shakespeare withdrew. The rebuilding was old-fashioned thinking, reverting to the company’s desire, asserted in 1594, to play indoors in winter, which helps to clarify their decisions and Shakespeare’s own—to write plays rather than more long poems. The few surviving papers of the Privy Council and the London mayoralty from the time suggest that one of the two new companies of 1594 preferred to play indoors during the winter instead of at their allocated open playhouses in the suburbs. They tried to renew this traditional practice, first in 1594 and again in 1596 when James Burbage built the indoor Blackfriars playhouse for them. The renewal of the Globe in 1614 was part of the same thinking, although Shakespeare evidently opted out of the decision.

An investigation of thermal comfort adaptation behaviour in office buildings in the UK

Around 40% of total energy consumption in the UK is consumed by creating comfortable indoor environment for occupants. Occupants’ behaviour in terms of achieving thermal comfort could have a significant impact on a building’s energy consumption. Therefore, understanding the interactions of occupants with their buildings would be essential to provide a thermal comfort environment that is less reliance on energy-intensive heating, ventilation and air-conditioning systems, to meet energysaving and carbon emission targets. This paper presents the findings of a year-long field study conducted in non-air-conditioned office buildings in the UK. Occupants’ adaptive responses in terms of technological and personal dimensions are dynamic processes which could vary with both indoor and outdoor thermal conditions. The adaptive behaviours of occupants in the surveyed building show substantial seasonal and daily variations. Our study shows that non-physical factors such as habit could influence the adaptive responses of occupants. However, occupants sometimes displayed inappropriate adaptive behaviour, which could lead to a misuse of energy. This paper attempts to illustrate how occupants would adapt and interact with their built environment and consequently contribute to development of a guide for future design/refurbishment of buildings and to develop energy management systems for a comfortable built environment.

Characterising the energy performance of centralised HVAC&R systems in the UK

Heating, ventilation, air conditioning and refrigeration (HVAC&R) systems account for more than 60% of the energy consumption of buildings in the UK. However, the effect of the variety of HVAC&R systems on building energy performance has not yet been taken into account within the existing building energy benchmarks. In addition, the existing building energy benchmarks are not able to assist decision-makers with HVAC&R system selection. This study attempts to overcome these two deficiencies through the performance characterisation of 36 HVAC&R systems based on the simultaneous dynamic simulation of a building and a variety of HVAC&R systems using TRNSYS software. To characterise the performance of HVAC&R systems, four criteria are considered; energy consumption, CO2 emissions, thermal comfort and indoor air quality. The results of the simulations show that, all the studied systems are able to provide an acceptable level of indoor air quality and thermal comfort. However, the energy consumption and amount of CO2 emissions vary. One of the significant outcomes of this study reveals that combined heating, cooling and power systems (CCHP) have the highest energy consumption with the lowest energy related CO2 emissions among the studied HVAC&R systems.

Inhalation exposure to particulate matter in rooms with underfloor air distribution

This work investigated the personal exposure to indoor particulate matters using the intake fraction metric and provided a possible way to trace the particle inhaled from an indoor particle source. A turbulence model validated by the particle measurements in a room with underfloor air distribution (UFAD) system was used to predict the indoor particle concentrations. Inhalation intake fraction of indoor particles was defined and evaluated in two rooms equipped with the UFAD, i.e., the experimental room and a small office. According to the exposure characteristics and a typical respiratory rate, the intake fraction was determined in two rooms with a continuous and episodic (human cough) source of particles, respectively. The findings showed that the well-mixing assumption of indoor air failed to give an accurate estimation of inhalation exposure and the average concentration at return outlet or within the overall room could not relate well the intake fraction to the amount of particle emitted from an indoor source.

Restricting microbial exposure in early life negates the immune benefits associated with gut colonization in environments of high microbial diversity

Background: Acquisition of the intestinal microbiota in early life corresponds with the development of the mucosal immune system. Recent work on caesarean-delivered infants revealed that early microbial composition is influenced by birthing method and environment. Furthermore, we have confirmed that early-life environment strongly influences both the adult gut microbiota and development of the gut immune system. Here, we address the impact of limiting microbial exposure after initial colonization on the development of adult gut immunity. Methodology/Principal Findings: Piglets were born in indoor or outdoor rearing units, allowing natural colonization in the immediate period after birth, prior to transfer to high-health status isolators. Strikingly, gut closure and morphological development were strongly affected by isolator-rearing, independent of indoor or outdoor origins of piglets. Isolator-reared animals showed extensive vacuolation and disorganization of the gut epithelium, inferring that normal gut closure requires maturation factors present in maternal milk. Although morphological maturation and gut closure were delayed in isolatorreared animals, these hard-wired events occurred later in development. Type I IFN, IL-22, IL-23 and Th17 pathways were increased in indoor-isolator compared to outdoor-isolator animals during early life, indicating greater immune activation in pigs originating from indoor environments reflecting differences in the early microbiota. This difference was less apparent later in development due to enhanced immune activation and convergence of the microbiota in all isolator-reared animals. This correlated with elevation of Type I IFN pathways in both groups, although T cell pathways were still more affected in indoor-reared animals. Conclusions/Significance: Environmental factors, in particular microbial exposure, influence expression of a large number of immune-related genes. However, the homeostatic effects of microbial colonization in outdoor environments require sustained microbial exposure throughout development. Gut development in high-hygiene environments negatively impacts on normal succession of the gut microbiota and promotes innate immune activation which may impair immune homeostasis.

Establishment of normal gut microbiota is compromised under excessive hygiene conditions

Background: Early gut colonization events are purported to have a major impact on the incidence of infectious, inflammatory and autoimmune diseases in later life. Hence, factors which influence this process may have important implications for both human and animal health. Previously, we demonstrated strong influences of early-life environment on gut microbiota composition in adult pigs. Here, we sought to further investigate the impact of limiting microbial exposure during early life on the development of the pig gut microbiota. Methodology/Principal Findings: Outdoor- and indoor-reared animals, exposed to the microbiota in their natural rearing environment for the first two days of life, were transferred to an isolator facility and adult gut microbial diversity was analyzed by 16S rRNA gene sequencing. From a total of 2,196 high-quality 16S rRNA gene sequences, 440 phylotypes were identified in the outdoor group and 431 phylotypes in the indoor group. The majority of clones were assigned to the four phyla Firmicutes (67.5% of all sequences), Proteobacteria (17.7%), Bacteroidetes (13.5%) and to a lesser extent, Actinobacteria (0.1%). Although the initial maternal and environmental microbial inoculum of isolator-reared animals was identical to that of their naturally-reared littermates, the microbial succession and stabilization events reported previously in naturally-reared outdoor animals did not occur. In contrast, the gut microbiota of isolator-reared animals remained highly diverse containing a large number of distinct phylotypes. Conclusions/Significance: The results documented here indicate that establishment and development of the normal gut microbiota requires continuous microbial exposure during the early stages of life and this process is compromised under conditions of excessive hygiene.

Expression of cyclooxygenase-2 in intestine of pigs of different ages and hygiene status

Prostaglandins (PG) are bioactive lipids derived from the metabolism of membrane polyunsaturated fatty acids (PUFA), and play important roles in a number of biological processes including cell division, immune responses and wound healing. Cyclooxygenase (COX) is the key enzyme in PG synthesis from arachidonic acid. The hypothesis of the present study was that expression of COX-2 in porcine intestine was dependent on the microbial load and the age of piglets. Piglets were obtained from sows raised either on outdoor free-range farms or on indoor commercial farms, and littermates were divided into three treatments: One group of piglets suckled the sow, a second group was put into an isolator and fed a milk formula, and a third group was put into the isolator fed milk formula and injected with broad spectrum antibiotics. Samples were collected from the 75% level of the small intestine at day 5, 28 and 56 of age. Tissue section from four piglets from each of these six treatment groups was analysed by immunofluorescence for COX-2 and type-IV collagen (basement membrane, defining lamina propria (LP)). Image analysis was used to determine the number of positive pixels expressing LP and epithelial COX-2. COX-2 expressing cells were observed in LP and epithelium in all porcine intestinal samples. When analysing images obtained on day 28, injection of antibiotics seemed to reduce the COX-2 expression in intestinal samples of piglets when compared to other treatments (P=0.053). No significant effect of farm, treatments or age of piglets was observed on COX-2 expressing data when analysing all data of images obtained at day 28 and 56. By double-labelling experiments, COX-2 was found not to be expressed on cell co-expressing CD45, CD16, CD163 or CD2, thus indicating that mucosal leukocytes, including dendritic cells, macrophages and NK cells did not express COX-2. Future research should investigate the role of COX-2 expression in the digestive tract in relation to pig health.

Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces

Background: Early microbial colonization of the gut reduces the incidence of infectious, inflammatory and autoimmune diseases. Recent population studies reveal that childhood hygiene is a significant risk factor for development of inflammatory bowel disease, thereby reinforcing the hygiene hypothesis and the potential importance of microbial colonization during early life. The extent to which early-life environment impacts on microbial diversity of the adult gut and subsequent immune processes has not been comprehensively investigated thus far. We addressed this important question using the pig as a model to evaluate the impact of early-life environment on microbe/host gut interactions during development. Results: Genetically-related piglets were housed in either indoor or outdoor environments or in experimental isolators. Analysis of over 3,000 16S rRNA sequences revealed major differences in mucosa-adherent microbial diversity in the ileum of adult pigs attributable to differences in earlylife environment. Pigs housed in a natural outdoor environment showed a dominance of Firmicutes, in particular Lactobacillus, whereas animals housed in a hygienic indoor environment had reduced Lactobacillus and higher numbers of potentially pathogenic phylotypes. Our analysis revealed a strong negative correlation between the abundance of Firmicutes and pathogenic bacterial populations in the gut. These differences were exaggerated in animals housed in experimental isolators. Affymetrix microarray technology and Real-time Polymerase Chain Reaction revealed significant gut-specific gene responses also related to early-life environment. Significantly, indoorhoused pigs displayed increased expression of Type 1 interferon genes, Major Histocompatibility Complex class I and several chemokines. Gene Ontology and pathway analysis further confirmed these results.

Joint compensation of multiple RF impairments in MIMO STBC systems

In this paper, we propose a compensation method for the joint effect of high-power amplifier (HPA) nonlinearity, in-phase/quadrature-phase (I/Q) imbalance and crosstalk in multiple-input multiple-output (MIMO) orthogonal space-time block coding (OSTBC) systems. The performance of the MIMO OSTBC equipped with the proposed compensation mechanism is evaluated in terms of average symbol error probability and system capacity, in Rayleigh fading channels. Numerical results are provided and show the effects on performance of several system parameters, namely, the HPA parameters, image-leakage ratio, crosstalk, numbers of antennas, and phase-shift keying modulation order.

Optimal beamforming in MIMO systems with HPA nonlinearity

In this paper, multiple-input multiple-output (MIMO) transmit beamforming (TB) systems under the consideration of nonlinear high-power amplifiers (HPAs) are investigated. The optimal beamforming scheme, with the optimal beamforming weight vector and combining vector, is proposed for MIMO systems with HPA nonlinearity. The performance of the proposed MIMO beamforming scheme in the presence of HPA nonlinearity is evaluated in terms of average symbol error probability (SEP), outage probability and system capacity, considering transmission over uncorrelated quasi-static frequency-flat Rayleigh fading channels. Numerical results are provided and show the effects of several system parameters, namely, parameters of nonlinear HPA, numbers of transmit and receive antennas, and modulation order of phase-shift keying (PSK), on performance.