Efficacy of personal protective equipment to prevent environmental infection of COVID-19 among healthcare workers: a systematic review

BACKGROUND@#Healthcare workers (HCWs) employed personal protective equipment (PPE) during the COVID-19 pandemic, crucial to protecting themselves from infection. To highlight the efficacy of PPE in preventing environmental infection among HCWs, a systematic review was conducted in line with PRISMA guidance.@*METHODS@#A search of the PubMed and Web of Science databases was conducted from January 2019 to April 2021 using pre-defined search terms. Articles were screened by three researchers. The approved papers were read in full and included in this review if relevance was mutually agreed upon. Data were extracted by study design and types of PPEs.@*RESULTS@#47 of 108 identified studies met the inclusion criteria, with seven reviews and meta-analyses, seven cohort, nine case-control, fifteen cross-sectional studies, four before and after, four case series, and one modeling studies. Wearing PPE offered COVID-19 protection in HCWs but required adequate training. Wearing surgical masks provided improved protection over cloth masks, while the benefit of powered air-purifying respirators is less clear, as are individual gowns, gloves, and/or face shields.@*CONCLUSIONS@#Wearing PPE, especially facial masks, is necessary among HCWs, while training in proper use of PPE is also important to prevent COVID-19 infection.

The incidence of diabetes among the non-diabetic residents in Kawauchi village, Fukushima, who experienced evacuation after the 2011 Fukushima Daiichi nuclear power plant disaster

OBJECTIVES@#After the Fukushima Daiichi nuclear power plant disaster in 2011, residents of Kawauchi village who experienced evacuation had a high risk of suffering from diabetes and metabolic syndrome compared with non-evacuees. In addition to evacuation, lifestyle characteristics can be important factors influencing the development and prognosis of diabetes or glucose tolerance. The current study aimed to evaluate the effects of evacuation (i.e., lifestyle changes) on the incidence of diabetes among the non-diabetic residents of Kawauchi village.@*METHODS@#Design is retrospective cohort study. Annual health examination data of residents of Kawauchi village and control area (Ono town) in Fukushima prefecture from 2008 to 2017, as available from the Japanese National Health Insurance system. Participants were classified into three groups: "Diabetes (DM)" (FBG ≥ 126 mg/dL or HbA1c ≥ 6.5% or hospital visit for DM or usage of diabetic medication), "Borderline DM" (126 mg/dL > FBG ≥ 110 mg/dL or 6.5% > HbA1c ≥ 6.0%, and without hospital visit, and without diabetic medication), and "Normoglycemic" (FBG < 110 mg/dL and HbA1c < 6.0%, and without hospital visit, and without diabetic medication). New onset of diabetes was evaluated and the events or missing data were occurred at health checkup. For this survival analysis, 339 residents in Kawauchi and 598 residents in Ono were included. Average follow-up periods after 2010 were 3.9 years in Kawauchi village and 3.6 years in Ono town.@*RESULTS@#Compared with the normoglycemic group, incidence of DM was much greater in the borderline DM group, where DM occurred among 38.2% of the group in 2012 and increased to over 60% cumulatively through 2017 in Kawauchi village. DM had a prevalence of 16.3% in 2012, and below 30% in 2017 in borderline DM group of Ono town. Cox proportional hazard regression analysis was applied to non-DM groups at both study sites separately to evaluate the effects of lifestyle changes at each site. While BMI, BMI change, and the lack of regular exercise (HR = 1.29, 1.72, and 5.04, respectively) showed significant associations with the onset of diabetes in Ono town, only BMI and late-night dinner (HR = 1.21 and 4.86, respectively) showed significant associations with diabetes onset in Kawauchi village.@*CONCLUSIONS@#The current results confirmed that diabetes incidence was increased 6 years after the Daiichi nuclear power plant disaster in Kawauchi. We also found changes in lifestyle habits, suggesting that diabetes prevention with promotion of healthy lifestyle behaviors is an urgent priority.

Reduction of alkali supplement in a pilot-scale thermophilic multi-staged UASB reactor treating alcohol distillery wastewater

One of the main disadvantages of anaerobic wastewater treatment at a low pH is the significant operational cost due to the addition of necessary alkali. To reduce alkali supplement and thus the cost, this study proposes a sequential multi-feed [SqMF] mode [distributed feeding] and effluent recycle [ER] mode. Experiments were conducted with a pilot-scale [2.5 m[3]] thermophilic [55°C] multi-staged up-flow anaerobic sludge blanket reactor. Alcohol distillery wastewater [shochu], a major source of industrial wastewater in Japan, was used for the study. The SqMF mode of operation [influent pH: 5.0; organic loading rate: 45 kgCOD/m[3]/day; HRT: 12 hours; influent COD concentration: 20,900 mgCOD/L] successfully reduced the alkali supplement [24% NaOH solution] requirement by 67.2% compared with the single-feed mode. For the ER mode operation [organic loading rate: 35 kgCOD/m[3]/day; HRT: 12 hours; influent COD concentration: 17,400 mgCOD/L], operation was possible without any alkali supplement since the system uses the alkalinity generated during microbial metabolism

Performance and microbial community analysis of a full-scale hybrid anaerobic-aerobic membrane system for treating molasses-based bioethanol wastewater

We evaluated the efficacy of a full-scale combined biophysicochemical system for treating molasses-based bioethanol wastewater in terms of organic substances, nutrient, and dark brown color removal. The main organic removal unit, i.e., the upflow anaerobic sludge blanket [UASB] reactor, achieved 80.7% removal and 4.3 Nm3 methane production per cubic meter of wastewater with a hydraulic retention time of 16.7 h. Downflow hanging sponge [DHS] reactors were important in reducing the biochemical oxygen demand [BOD], and the lowest possible organic waste intake prevented excessive biomass formation. The BOD removal efficiency was 71.2-97.9%. The denitrification upflow anaerobic fixed bed [UFB] reactor achieved 99.2% total nitrogen removal. Post-physicochemical membrane treatment reduced the total phosphate, color, and remaining organic matter by 90.4%, 99.1%, and 99.8%, respectively. We analyzed the microbial diversity of the sludge from the UASB reactors. Methanosaeta was the dominant archaeal genus in the system, followed by Methanolinea, Methanomicrospillum, Caldiserica, Bacteroidetes, and Deltaproteobacteria

Direct treatment of settled sewage by DHS reactors with different sizes of sponge support media

The down-flow hanging sponge [DHS] reactor, which was developed for post-treatment of effluent from up-flow anaerobic sludge blanket [UASB] process treating sewage, uses polyurethane sponge as media to retain biomass. Wastewater is trickled from the top of the reactor and purified by microorganisms retained both inside and outside of the sponge media as the wastewater flows vertically down through the reactor. Three DHS reactors employing different sizes of sponge media with the same total sponge volume were used for the direct treatment of settled sewage. All the reactors exhibited excellent performance in removal of COD, ammonium nitrogen, and fecal coliform at a fixed hydraulic retention time of 2.0 h based on the sponge volume. It was shown that smaller sponge media produced better removal efficiencies for all the parameters listed above. The most reasonable explanation for this might be that smaller sponge media allows better oxygen uptake in the stream flowing down through the reactors

Evaluation of treatment characteristics and sludge properties in a UASB, reactor treating municipal sewage at ambient temperature

The evaluation of treatment characteristics and sludge properties of an upflow anaerobic sludge blanket [UASB] process was investigated using a pilot-scale 1.15 m[3]reactor. The UASB, inoculated with digester sludge, was operated at a hydraulic retention time of 8 h at sewage temperatures ranging from 10.6 to 27.7 °C for more than 1100 days. The stable removal efficiencies for total COD[Cr] and SS were 63 +/- 13% and 66 +/- 20%, respectively. The average concentration of the retained sludge increased to more than 24.5 gSS/L of the column volume after two years of operation. In summer, the water temperature increased above 20 °C, and biodegradation of solid organic matter was enhanced. The solid retention time was evaluated to be as long as 293 +/- 114 days; this is sufficient for mineralisation of solid organic matter, as indicted by a low sludge conversion of 0.029 gVSS/gCOD[removed] and a growth yield of 0.132 gVSS/gCOD, determined by seasonal sludge profiling. The bacterial communities, based on bacterial 16S rRNA genes in the retained sludge, were significantly diverse. Bacteroidetes and Firmicutes were the dominant phyla of the decomposers of solid organic matter in the library. A Ruminocoecus-related clone detected in the Firmicutes phylum acted as a cellulose decomposer

Paradoxical increases in serum levels of highly chlorinated PCBs in aged women in clear contrast to robust decreases in dietary intakes from 1980 to 2003 in Japan

<p><b>OBJECTIVE</b>Exposure to polychlorinated biphenyls (PCBs) is considered to have culminated between 1950 and 1970 in Japan, and exposure through diet, the major exposure route, has decreased significantly over the last 10 years. The primary goal of the present study was to investigate the long-term trends and congener profiles of serum and dietary levels of PCBs using historical samples.</p><p><b>METHODS</b>Using banked samples collected in 1980, 1995, and 2003 surveys, we determined the daily intakes and serum concentrations of 13 PCB congeners (#74, #99, #118, #138, #146, #153, #156, #163, #164, #170, #180, #182, and #187) in women.</p><p><b>RESULTS</b>The total daily PCB intake [ng/day, geometric mean (geometric standard deviation)] decreased significantly from 523 (2.5) in 1980 to 63 (3.2) in 2003. The serum total PCB level (ng/g lipid) in women <40 years of age decreased significantly from 185 (1.8) in 1980 to 68 (1.8) in 2003. In contrast, the level in women >50 years of age increased significantly from 125 (1.7) in 1980 to 242 (1.7) in 2003. Specifically, the serum concentrations of hexa (#138, #146, #153, #156, #163, and #164) and hepta (#170, #180, #182, and #187) congeners increased significantly. A comparison of the serum PCB levels of women born from 1940 to 1953 revealed that their serum total PCB level was significantly higher in the 2003 survey [242 (1.7), n = 9] than in the 1995 [128 (2.0), n = 17] surveys. This increase in the total PCB level was attributable to increases in the hepta congener groups.</p><p><b>CONCLUSION</b>Present results suggest a decreased rate of elimination of hepta congeners with aging in females, rather than a birth-generation phenomenon.</p>

Environmental and biological monitoring of persistent fluorinated compounds in Japan and their toxicities

Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) comprise a class of per- and poly-fluorinated compounds that have been detected in the environment as well as in humans. The aim of this review is to summarize several monitoring studies in Japan and characterize the toxicokinetics of these compounds. We found that the levels of contamination by these compounds had unique patterns in Japan. The levels of PFOA in serum from inhabitants of the Kansai region were higher than those of other regions. The PFOA levels in air and water samples from the Kansai region were also relatively high. The estimated intakes from these routes partly explain the differences in the serum levels. The toxicokinetics of these compounds have been investigated. Serum samples from male participants had significantly higher geometric means for PFOS and PFOA compared to samples from female participants. This sex-related difference was partly simulated by menstrual blood loss. There are large interspecies differences in the excretion pathways of these compounds. The serum clearances of PFOA via urine were 300-1,000-fold lower in humans than in Wistar rats and Japanese macaques. On the other hand, the biliary excretion of these compounds was comparable in rats and humans, and the long half-lives in humans may be attributable to the low levels of urinary excretion and high biliary reabsorption rates. These findings suggest that qualitative differences in the excretion routes exist between humans and other species. For risk assessment of these compounds, further information regarding sources of exposure and their toxicokinetics is needed.

Reconstruction of human exposure to heavy metals using synchrotron radiation microbeams in prehistoric and modern humans

<p><b>OBJECTIVE</b>Teeth can serve as records of environmental exposure to heavy metals during their formation. We applied a new technology - synchrotron radiation microbeams (SRXRF) - for analysis of heavy metals in human permanent teeth in modern and historical samples.</p><p><b>METHODS</b>Each tooth was cut in half. A longitudinal section 200 mum in thickness was subjected to the determination of the heavy metal content by SRXRF or conventional analytical methods (ICP-MS analysis or reduction-aeration atomic absorption spectrometry). The relative concentrations of Pb, Hg, Cu and Zn measured by SRXRF were translated in concentrations (in g of heavy metal/g of enamel) using calibration curves by the two analytical methods.</p><p><b>RESULTS</b>Concentrations in teeth in the modern females (n = 5) were 1.2 +/- 0.5 mug/g (n = 5) for Pb; 1.7 +/- 0.2 ng/g for Hg; 0.9 +/- 1.1 mug/g for Cu; 150 +/- 24.6 mug/g for Zn. The levels of Pb were highest in the teeth samples obtained from the humans of the Edo era (1603-1868 AD: ) (0.5-4.0 mug/g, n = 4). No trend was observed in this study in the Hg content in teeth during 3,000 years. The concentrations of Cu were highest in teeth of two medieval craftsmen (57.0 and 220 mug/g). The levels of Zn were higher in modern subjects (P < 0.05) than those in the Jomon (~1000 BC: ) to Edo periods [113.2 +/- 27.4 (mug/g, n = 11)]. Reconstruction of developmental exposure history to lead in a famous court painter of the Edo period (18th century) revealed high levels of Pb (7.1-22.0 mug/g) in his childhood.</p><p><b>CONCLUSIONS</b>SRXRF is useful a method for reconstructing human exposures in very long trends.</p>

Intermittent effluent recirculation for the efficient treatment of low strength wastewater by an EGSB reactor

In order to establish the appropriate methane fermentation technology for low strength wastewater, a 2.0 L EGSB reactor was operated at 20°C with 0.3 - 0.4 g COD/L of sucrose-based synthetic wastewater for 500 days. At the start up period, the reactor was operated in EGSB mode with a 5 m/h up flow velocity by continuous effluent recirculation. However, the EGSB reactor exhibited insufficient COD removal [50-60%] at COD loading of 7.2 - 9.6 kg COD/m3.day due to the low COD concentration in the sludge bed. Therefore, we proposed the new operation mode by switching to UASB mode [without recirculation, 0.7 m/h up flow velocity] for 30 minutes and EGSB mode for 10 minutes in 40 minutes cycle. Moreover we added sodium sulfide to make the low ORP condition. In this operation, COD removal increased dramatically, from 65% to 91%. Additionally, physical properties of the retained sludge were well maintained in this operation mode. Furthermore, the retained sludge possessed appropriate levels of methanogenic activity [0.2-0.4 g COD/g VSS/day] at 20°C

Negative results ofumu genotoxicity test of fluorotelomer alcohols and perfluorinated alkyl acids

<p><b>OBJECTIVES</b>Recently, perfluorooctanoate (PFOA) has been ubiquitously detected in the environment as well as in human serum. Fluorotelomer alcohols (FTOHs), a precursor of PFOA, undergo biodegradation via several metabolic routes which leads to formation of various biodegradation products. The degradation of FTOHs produces an α,β-unsaturated aldehyde that seems possibly to be electrophilic and may react with cellular macromolecules including DNA.</p><p><b>METHODS</b>We investigated the genotoxicity of three FTOHs (6∶2 FTOH, 8∶2 FTOH and 10∶2 FTOH), PFOA and perfluorooctane sulfonate (PFOS) using theumu test.</p><p><b>RESULTS</b>The FTOHs, PFOA and PFOS showed no significant increases in β-galactosidase activity at 0-1000 μM in the absence of S9 mix. The results were unchanged by the metabolic activation with S9 mix.</p><p><b>CONCLUSION</b>The genotoxicities of FTOHs, PFOA or PFOS are not detectable using the present method, suggesting that they are unlikely mutagens.</p>

Negative Results of \it{umu} Genotoxicity Test of Fluorotelomer Alcohols and Perfluorinated Alkyl Acids

Objectives: Recently, perfluorooctanoate (PFOA) has been ubiquitously detected in the environment as well as in human serum. Fluorotelomer alcohols (FTOHs), a precursor of PFOA, undergo biodegradation via several metabolic routes which leads to formation of various biodegradation products. The degradation of FTOHs produces an α,β-unsaturated aldehyde that seems possibly to be electrophilic and may react with cellular macromolecules including DNA. Methods: We investigated the genotoxicity of three FTOHs (6:2 FTOH, 8:2 FTOH and 10:2 FTOH), PFOA and perfluorooctane sulfonate (PFOS) using the umu test. Results: The FTOHs, PFOA and PFOS showed no significant increases in β-galactosidase activity at 0−1000 μM in the absence of S9 mix. The results were unchanged by the metabolic activation with S9 mix. Conclusion: The genotoxicities of FTOHs, PFOA or PFOS are not detectable using the present method, suggesting that they are unlikely mutagens.