Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises.

INTRODUCTION: Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient. OBJECTIVE: To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy. METHODS: We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task. RESULTS: All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition. CONCLUSIONS: Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.

Review of Motion Simulation of Particulate Matter in the Respiratory System and Further CFD Simulations on COVID-19

Respirable particulate matter (RSP) is currently very harmful to the human body, potentially causing pulmonary silicosis, allergic rhinitis, acute bronchitis, and pulmonary heart disease. Therefore, the study of the deposition pattern of RSP in the human respiratory system is key in the prevention, treatment, and research of related diseases, whereby the main methods are computer simulation, in vitro solid models, and theoretical analysis. This paper summarizes and analyzes past deposition of RSP in the respiratory tract and also describes them in specific case studies such as COPD and COVID-19 patients, based on the review of the evidence, direction, and focus of future research focusing on simulation, experimentation, and related applications of RSP deposition in the respiratory tract. © 2023 by the authors.

Quantification of Respirable Aerosol Particles from Speech and Language Therapy Exercises.

INTRODUCTION: Voice assessment and treatment involve the manipulation of all the subsystems of voice production, and may lead to production of respirable aerosol particles that pose a greater risk of potential viral transmission via inhalation of respirable pathogens (eg, SARS-CoV-2) than quiet breathing or conversational speech. OBJECTIVE: To characterise the production of respirable aerosol particles during a selection of voice assessment therapy tasks. METHODS: We recruited 23 healthy adult participants (12 males, 11 females), 11 of whom were speech-language pathologists specialising in voice disorders. We used an aerodynamic and an optical particle sizer to measure the number concentration and particle size distributions of respirable aerosols generated during a variety of voice assessment and therapy tasks. The measurements were carried out in a laminar flow operating theatre, with a near-zero background aerosol concentration, allowing us to quantify the number concentration and size distributions of respirable aerosol particles produced from assessment/therapy tasks studied. RESULTS: Aerosol number concentrations generated while performing assessment/therapy tasks were log-normally distributed among individuals with no significant differences between professionals (speech-language pathologists) and non-professionals or between males and females. Activities produced up to 32 times the aerosol number concentration of breathing and 24 times that of speech at 70-80 dBA. In terms of aerosol mass, activities produced up to 163 times the mass concentration of breathing and up to 36 times the mass concentration of speech. Voicing was a significant factor in aerosol production; aerosol number/mass concentrations generated during the voiced activities were 1.1-5 times higher than their unvoiced counterpart activities. Additionally, voiced activities produced bigger respirable aerosol particles than their unvoiced variants except the trills. Humming generated higher aerosol concentrations than sustained /a/, fricatives, speaking (70-80 dBA), and breathing. Oscillatory semi-occluded vocal tract exercises (SOVTEs) generated higher aerosol number/mass concentrations than the activities without oscillation. Water resistance therapy (WRT) generated the most aerosol of all activities, ∼10 times higher than speaking at 70-80 dBA and >30 times higher than breathing. CONCLUSIONS: All activities generated more aerosol than breathing, although a sizeable minority were no different to speaking. Larger number concentrations and larger particle sizes appear to be generated by activities with higher suspected airflows, with the greatest involving intraoral pressure oscillation and/or an oscillating oral articulation (WRT or trilling).

Disparate air pollution reductions during California’s COVID-19 economic shutdown

Minority communities in the United States often experience higher-than-average exposures to air pollution. However, the relative contribution of institutional biases to these disparities can be difficult to disentangle from other factors. Here, we use the economic shutdown associated with the 2020 COVID-19 shelter-in-place orders to causally estimate pollution exposure disparities caused by the in-person economy in California. Using public and citizen-science ground-based monitor networks for respirable particulate matter, along with satellite records of nitrogen dioxide, we show that sheltering in place produced disproportionate air pollution reductions for non-White (especially Hispanic and Asian) and low-income communities. We demonstrate that these racial and ethnic effects cannot be explained by weather patterns, geography, income or local economic activity as measured by local changes in mobility. They are instead driven by regional economic activity, which produces local harms for diffuse economic benefits. This study thus provides indirect, yet substantial, evidence of systemic racial and ethnic bias in the generation and control of pollution from the portion of the economy most impacted in the early pandemic period. © 2022, The Author(s), under exclusive licence to Springer Nature Limited.

Characterisation of Particle Size and Viability of SARS-CoV-2 Aerosols from a Range of Nebuliser Types Using a Novel Sampling Technique.

Little is understood about the impact of nebulisation on the viability of SARS-CoV-2. In this study, a range of nebulisers with differing methods of aerosol generation were evaluated to determine SARS-CoV-2 viability following aerosolization. The aerosol particle size distribution was assessed using an aerosol particle sizer (APS) and SARS-CoV-2 viability was determined after collection into liquid media using All-Glass Impingers (AGI). Viable particles of SARS-CoV-2 were further characterised using the Collison 6-jet nebuliser in conjunction with novel sample techniques in an Andersen size-fractioning sampler to predict lung deposition profiles. Results demonstrate that all the tested nebulisers can generate stable, polydisperse aerosols (Geometric standard deviation (GSD) circa 1.8) in the respirable range (1.2 to 2.2 µm). Viable fractions (VF, units PFU/particle, the virus viability as a function of total particles produced) were circa 5 × 10-3. VF and spray factors were not significantly affected by relative humidity, within this system where aerosols were in the spray tube an extremely short time. The novel Andersen sample collection methods successfully captured viable virus particles across all sizes; with most particle sizes below 3.3 µm. Particle sizes, in MMAD (Mass Median Aerodynamic Diameters), were calculated from linear regression of log10-log10 transformed cumulative PFU data, and calculated MMADs accorded well with APS measurements and did not differ across collection method types. These data will be vital in informing animal aerosol challenge models, and infection prevention and control policies.

Efficacy of dental evacuation systems for aerosol exposure mitigation in dental clinic settings.

Dental personnel are ranked among the highest risk occupations for exposure to SARS-CoV-2 due to their close proximity to the patient's mouth and many aerosol generating procedures encountered in dental practice. One method to reduce aerosols in dental settings is the use of intraoral evacuation systems. Intraoral evacuation systems are placed directly into a patient's mouth and maintain a dry field during procedures by capturing liquid and aerosols. Although multiple intraoral dental evacuation systems are commercially available, the efficacy of these systems is not well understood. The objectives of this study were to evaluate the efficacy of four dental evacuation systems at mitigating aerosol exposures during simulated ultrasonic scaling and crown preparation procedures. We conducted real-time respirable (PM4) and thoracic (PM10) aerosol sampling during ultrasonic scaling and crown preparation procedures while using four commercially available evacuation systems: a high-volume evacuator (HVE) and three alternative intraoral systems (A, B, C). Four trials were conducted for each system. Respirable and thoracic mass concentrations were measured during procedures at three locations including (1) near the breathing zone (BZ) of the dentist, (2) edge of the dental operatory room approximately 0.9 m away from the mannequin mouth, and (3) hallway supply cabinet located approximately 1.5 m away from the mannequin mouth. Respirable and thoracic mass concentrations measured during each procedure were compared with background concentrations measured in each respective location. Use of System A or HVE reduced thoracic (System A) and respirable (HVE) mass concentrations near the dentist's BZ to median background concentrations most often during the ultrasonic scaling procedure. During the crown preparation, use of System B or HVE reduced thoracic (System B) and respirable (HVE or System B) near the dentist's BZ to median background concentrations most often. Although some differences in efficacy were noted during each procedure and aerosol size fraction, the difference in median mass concentrations among evacuation systems was minimal, ranging from 0.01 to 1.48 µg/m3 across both procedures and aerosol size fractions.

Assessment of respirable aerosol concentrations using local ventilation controls in an open multi-chair dental clinic.

Dental procedures require patients to be unmasked throughout most of a dental visit, with some procedures generating both inhalable and respirable aerosols. Understanding aerosol generation and transport were important to developing protocols to protect both the patient and workers in dental environments early in the COVID pandemic. This study investigated the need, suitability, and effectiveness of using local exhaust ventilation units during patient procedures and examined the impact of patient density in a large, multi-chair dental clinic at an academic institution. Phase One measured respirable aerosol concentrations at the dental assistant's breathing zone and in neighboring unoccupied patient operatories. Results were compared during four dental procedures with three local ventilation (LV) options, with a single faculty performing procedures on a simulated patient. Phase Two deployed LV in all active patient operatories during procedures on actual patients and examined the impact of clinic patient occupancy on respirable aerosol concentrations throughout the clinic. During Phase One, respirable aerosol concentrations in nearby operatories were significantly higher during ultrasonic scaling (mean = 3.8 and SD = 0.3 µg/m3) and lower during rubber cup polishing (mean = 0.8 and SD = 0.5 mg/m3) (p < 0.001). While the same trend was identified for the dental assistant, differences were not significant. There was no difference in respirable aerosol concentrations by LV type when measured at the dental assist (p = 0.51, task means 3 to 32. 5 µg/m3) or neighboring rooms (p = 0.93, task means 0.6 to 4.0 µg/m3), indicating no improved control for any device tested. For Phase Two, the clinic deployed the extraoral suction (EOS) system in each patient operatory. The background-adjusted aerosol concentrations were significantly reduced (F < 0.001) when the operatories were occupied at 50% compared to 25%, likely attributed to increased air filtration of the room with double the EOS systems in use. While this study provides only a single case investigation, findings confirming respirable aerosol concentrations by procedure and across days provided insights into patient scheduling, local exhaust ventilation selection, and operation, which could be useful to other open multi-chair dental clinics.

COVID-19's lockdown effect on air quality in Indian cities using air quality zonal modeling.

The complete lockdown due to COVID-19 pandemic has contributed to the improvement of air quality across the countries particularly in developing countries including India. This study aims to assess the air quality by monitoring major atmospheric pollutants such as AOD, CO, PM2.5, NO2, O3 and SO2 in 15 major cities of India using Air Quality Zonal Modeling. The study is based on two different data sources; (a) grid data (MODIS- Terra, MERRA-2, OMI and AIRS, Global Modeling and Assimilation Office, NASA) and (b) ground monitoring station data provided by Central Pollution Control Board (CPCB) / State Pollution Control Board (SPCB). The remotely sensed data demonstrated that the concentration of PM2.5 has declined by 14%, about 30% of NO2 in million-plus cities, 2.06% CO, SO2 within the range of 5 to 60%, whereas the concentration of O3 has increased by 1 to 3% in majority of cities compared with pre lockdown. On the other hand, CPCB/SPCB data showed more than 40% decrease in PM2.5 and 47% decrease in PM10 in north Indian cities, more than 35% decrease in NO2 in metropolitan cities, more than 85% decrease in SO2 in Chennai and Nagpur and more than 17% increase in O3 in five cities amid 43 days pandemic lockdown. The restrictions of anthropogenic activities have substantial effect on the emission of primary atmospheric pollutants.

Spatial distribution characteristics of PM2.5 and PM10 in Xi'an City predicted by land use regression models.

PM2.5 and PM10 could increase the risk for cardiovascular and respiratory diseases in the general public and severely limit the sustainable development in urban areas. Land use regression models are effective in predicting the spatial distribution of atmospheric pollutants, and have been widely used in many cities in Europe, North America and China. To reveal the spatial distribution characteristics of PM2.5 and PM10 in Xi'an during the heating seasons, the authors established two regression prediction models using PM2.5 and PM10 concentrations from 181 monitoring stations and 87 independent variables. The model results are as follows: for PM2.5, R2 = 0.713 and RMSE = 8.355 µg/m3; for PM10, R2 = 0.681 and RMSE = 14.842 µg/m3. In addition to the traditional independent variables such as area of green space and road length, the models also include the numbers of pollutant discharging enterprises, restaurants, and bus stations. The prediction results reveal the spatial distribution characteristics of PM2.5 and PM10 in the heating seasons of Xi'an. These results also indicate that the spatial distribution of pollutants is closely related to the layout of industrial land and the location of enterprises that generate air pollution emissions. Green space can mitigate pollution, and the contribution of traffic emission is less than that of industrial emission. To our knowledge, this study is the first to apply land use regression models to the Fenwei Plain, a heavily polluted area in China. It provides a scientific foundation for urban planning, land use regulation, air pollution control, and public health policy making. It also establishes a basic model for population exposure assessment, and promotes the sustainability of urban environments.