Public toilets with insufficient ventilation present high cross infection risk.

Due to insufficient ventilation, public toilets present high risks for cross-infection. The study investigated 61 public toilets to identify the causes and locations of biological contaminated sources. Airborne and surface bacterial contamination, carbon dioxide concentration, and surface ammonia levels were measured. Both bacterial contamination and CO2 are higher in non-ventilated toilets compared to their ventilated counterparts. Bacteria colony forming units (CFUs) in a public toilet with poor ventilation can reach 5 times the number of CFUs outside of the toilet. This suggests that non-ventilated public toilets present a higher risk of cross-infection. Areas near all kinds of sanitary equipment (toilet bowls, squat toilets and urinals) were highly contaminated, indicating that enhanced cleaning regimes are necessary. Further, lidless trash bins present a higher risk as contaminated matter within the trash bins is not inhibited from being released into the environment. Ventilation and cleaning need to be improved to mitigate the risk of cross-infection in public toilets.

Effectiveness of a personalized ventilation system in reducing personal exposure against directly released simulated cough droplets.

UNLABELLED: The inhalation intake fraction was used as an indicator to compare effects of desktop personalized ventilation and mixing ventilation on personal exposure to directly released simulated cough droplets. A cough machine was used to simulate cough release from the front, back, and side of a thermal manikin at distances between 1 and 4 m. Cough droplet concentration was measured with an aerosol spectrometer in the breathing zone of a thermal manikin. Particle image velocimetry was used to characterize the velocity field in the breathing zone. Desktop personalized ventilation substantially reduced the inhalation intake fraction compared to mixing ventilation for all investigated distances and orientations of the cough release. The results point out that the orientation between the cough source and the breathing zone of the exposed occupant is an important factor that substantially influences exposure. Exposure to cough droplets was reduced with increasing distance between cough source and exposed occupant. PRACTICAL IMPLICATIONS: The results from this study show that an advanced air distribution system such as personalized ventilation reduces exposure to cough-released droplets better than commonly applied overhead mixing ventilation. This work can inform HVAC engineers about different aspects of air distribution systems' performance and can serve as an aid in making critical design decisions.

Human convection flow in spaces with and without ventilation: personal exposure to floor-released particles and cough-released droplets.

UNLABELLED: The effects of the human convective boundary layer (CBL), room airflow patterns, and their velocities on personal exposure are examined. Two pollutants are studied which simulate particles released from the feet and generated at distances of 2 and 3 m by a human cough. A thermal manikin whose body shape, size, and surface temperatures correspond to those of an average person is used to simulate the CBL. The findings of the study reveal that for accurate predictions of personal exposure, the CBL needs to be considered, as it can transport the pollution around the human body. The best way to control and reduce personal exposure when the pollution originates at the feet is to employ transverse flow from in front and from the side, relative to the exposed occupant. The flow from the above opposing the CBL create the most unfavorable velocity field that can increase personal exposure by 85%, which demonstrates a nonlinear dependence between the supplied flow rate and personal exposure. In the current ventilation design, it is commonly accepted that an increased amount of air supplied to the rooms reduces the exposure. The results of this study suggest that the understanding of air patterns should be prioritized. PRACTICAL IMPLICATIONS: A human convective boundary layer plays an important role in pollution transport around the human body. It interacts with the surrounding airflows which modifies air movement around the human body and personal exposure. Understanding the influence of this interaction on the pollution spread around the human can be used to control and reduce personal exposure and improve HVAC design.

Human convective boundary layer and its interaction with room ventilation flow.

This study investigates the interaction between the human convective boundary layer (CBL) and uniform airflow with different velocity and from different directions. Human body is resembled by a thermal manikin with complex body shape and surface temperature distribution as the skin temperature of an average person. Particle image velocimetry (PIV) and pseudocolor visualization (PCV) are applied to identify the flow around the manikin's body. The findings show that the direction and magnitude of the surrounding airflows considerably influence the airflow distribution around the human body. Downward flow with velocity of 0.175 m/s does not influence the convective flow in the breathing zone, while flow at 0.30 m/s collides with the CBL at the nose level reducing the peak velocity from 0.185 to 0.10 m/s. Transverse horizontal flow disturbs the CBL at the breathing zone even at 0.175 m/s. A sitting manikin exposed to airflow from below with velocity of 0.30 and 0.425 m/s assisting the CBL reduces the peak velocity in the breathing zone and changes the flow pattern around the body, compared to the assisting flow of 0.175 m/s or quiescent conditions. In this case, the airflow interaction is strongly affected by the presence of the chair.

Impact of asthma, exposure period, and filters on human responses during exposures to ozone and its initiated chemistry products.

The impact of asthma, exposure period, and filter condition downstream of the mixing box of air-conditioning system on building occupants' perceptual response, work performance, and salivary α-amylase secretion during exposures to ozone and its initiated chemistry products is studied. The experiments were conducted in a field environmental chamber (FEC) (240 m(3)) simulating an office environment. Experiments were conducted during periods when the air-handling system operated with new or used pleated panel filters at constant recirculation (7/h) and ventilation (1/h) rates. Average ozone and secondary organic aerosols (ozone-initiated chemistry products) measured during non-asthmatic and asthmatic subjects' 3-h exposures in the FEC were in the ranges approximately 20-37 ppb and approximately 1.6-3 µg/m(3), respectively. Asthmatic subjects' perceived odor intensity and sensory (eye, nose, and throat) irritation ratings were generally lower than those of non-asthmatic subjects, possibly explaining why asthmatic subjects accept perceived air quality more than non-asthmatic subjects. However, asthmatic subjects' perceived physiological-like symptom ratings (flu, chest tightness, and headache) and concentrations of secreted salivary α-amylase were generally higher than those of non-asthmatic subjects. Asthmatic subjects had significantly lower accuracy than non-asthmatic subjects in a task that required higher concentration although they had higher work speed. Filter condition did not make any significant difference for subjects' responses.

Laparoscopic sleeve gastrectomy: a novel procedure for weight loss.

INTRODUCTION: Morbid obesity is associated with increased morbidity and mortality. Bariatric surgery offers morbidly obese individuals substantial and sustainable weight loss and reduction in obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) is a new restrictive procedure in bariatric surgery. We aimed to evaluate our experience with LSG with regard to its safety and feasibility and early weight loss. METHODS: The surgical outcome, complications and early clinical results of all patients who underwent LSG at Singapore General Hospital were studied. RESULTS: 30 patients underwent LSG between December 2008 and October 2010. The mean preoperative weight of the patients was 113.4 (range 91.0-170.0) kg, while the mean body mass index (BMI) was 42.6 (range 33.0-60.0) kg/m². Diabetes mellitus was present in 39 percent of the patients, hypertension in 43 percent, hyperlipidaemia in 35 percent, obstructive sleep apnoea in 30 percent and osteoarthritis in 22 percent. The majority of patients had two or more obesity-related comorbidities (52 percent). Mean operative time was 142 (range 80-220) minutes and median duration of postoperative stay was three days. At two weeks, one, three and six months post operation, the mean BMI was 38.6 kg/m², 37.8 kg/m², 34.5 kg/m² and 30.8 kg/m², the mean percentage of excess weight loss was 17.7 percent, 23.3 percent, 40.9 percent and 56.7 percent, and absolute weight loss was 8.00 kg, 11.52 kg, 18.77 kg and 26.85 kg, respectively. CONCLUSION: LSG is a promising procedure for surgical treatment of obesity, with good early weight loss and low morbidity.

Home exposures to environmental tobacco smoke and allergic symptoms among young children in Singapore.

BACKGROUND: Research relating environmental tobacco smoke (ETS) exposures have focused on childhood asthma. There have been fewer studies with conflicting results performed on associations of ETS exposures with allergic symptoms. We are interested to see if ETS exposures in the homes are associated with allergic symptoms among preschool children in Singapore where public smoking is banned. METHODS: A cross-sectional study adopting an expanded and modified ISAAC (International Study on Asthma and Allergies in Childhood) questionnaire for the evaluation of asthma and allergies was conducted on 6,794 children attending 120 randomly selected child care centers. Specific information on demographics and ETS exposures was obtained. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were determined using Poisson multivariate regression with a log-link function and robust variance estimates as recommended for cross-sectional studies. RESULTS: The response proportion was 70.0%, and 4,759 children from 97 centers participated. After adjusting for covariates, it was found that home ETS exposure was associated with increased risks of current symptoms of rhinitis (PR 1.23; 95% CI 1.01-1.50) and rhinoconjunctivitis (PR 1.79; 95% CI 1.26-2.54). These associations followed dose-response trends with respect to number of cigarettes smoked or smokers in the homes. Home ETS exposures were also associated with higher PRs of wheeze, nocturnal cough and doctor-diagnosed asthma. Compared with paternal smoking, higher risks of the above outcomes were found for maternal smoking. CONCLUSION: Home ETS exposure is a risk factor associated with rhinitis and asthma among preschool children.

The effect of ventilation strategies of child care centers on indoor air quality and respiratory health of children in Singapore.

UNLABELLED: This paper reports the effects of ventilation strategies on indoor air quality (IAQ) and respiratory health of children within 104 child care centers (CCCs) in a hot and humid climate. The CCCs were categorized by ventilation strategies: natural (NV), air-conditioned and mechanically ventilated (ACMV), air-conditioned using split units (AC), and hybrid (NV and AC operated intermittently). The concentration levels of IAQ parameters in NV CCCs are characterized by the influence of the outdoors and good dilution of indoor pollutants. The lower ventilation rates in air-conditioned CCCs result in higher concentrations of occupant-related pollutants but lower outdoor pollutant ingress. This study also revealed lower prevalence for most asthma and allergy, and respiratory symptoms in children attending NV CCCs. In multivariate analyses controlled for the effects of confounders, the risk of current rhinitis among children is significantly higher if they attend mechanically ventilated CCCs compared to NV CCCs. Air-conditioned CCCs were also associated with higher adjusted prevalence ratio of severe phlegm and cough symptoms and lower respiratory illness. Finally, children attending CCCs with hybrid ventilation are at high risk for almost all the respiratory symptoms studied. PRACTICAL IMPLICATIONS: This large field study indicates that different ventilation strategies employed by child care centers can cause significant variations in the indoor air quality and prevalence of asthma, allergies and respiratory symptoms of attending children. The higher prevalence rates of allergic and respiratory symptoms among young children, whose immune system is still under-developed, in child care centers, whether fully or partially air-conditioned, suggest that ventilation and plausible growth and propagation mechanisms of allergens and infectious agents be further investigated.

Lessons from SARS in an age of emerging infections.

SARS, the first pandemic of this century, commanded the world's attention and required public health actions at the national and international levels. In an age of emerging infections, the lessons learnt from combating SARS can be used to improve our preparedness capabilities in three key areas to effectively tackle a public health emergency of international concern. The first area is in outbreak alert, which encompasses use of surveillance to detect, assess, notify and report events involving death or disease, and share information widely to enable proper risk assessment. The system must able to build up a comprehensive picture with appropriate warning for zoonotic diseases, environmental health and food safety. The second area is in public health response. In the event of an outbreak alert, the authorities must be able to quickly investigate cases/deaths and institute comprehensive control measures to break the chain of transmission. Protection of healthcare workers and reducing the opportunities for spread of infection through contact tracing and quarantine are important. The third area is in international health. This comprises health requirements for inbound and outbound travellers at the border checkpoints and global information exchange to mitigate the risks of travel abroad. Extrapolating these lessons to a wider public health context, our rapidly changing global infectious diseases situation mandates that we evaluate all available public health tools and build institutional capacity to effectively manage emerging infections.

Size relationship between airborne viable bacteria and particles in a controlled indoor environment study.

UNLABELLED: An attempt was made to determine the relationship between airborne viable bacteria (predominantly of human origin) and particle concentrations of different sizes in a controlled environmental chamber focusing on the effect of temperature setting. At temperature settings of 20 degrees and 26 degrees C, six subjects performed simulated office work for 2.5 h, and the particle and total bacteria concentrations at six aerodynamically corresponding size ranges were measured at 20-min intervals. The study revealed that the main contributor of viable bacteria was humans. Viable bacteria concentrations in the size range between 1 and 3 microm was higher at 20 degrees C than at 26 degrees C. Bacteria >7.5 microm showed good correlation with particles of similar minimum size, and it is postulated that this may be because of bacteria rafting on skin scales shed by the subjects. At sizes between 3 and 7.5 microm, the correlations indicated that bacteria exists as clumps, while at size ranges between 1.0 and 2 microm bacteria exists freely. At 26 degrees C, bacteria of size >7.5 microm correlated with exhaled carbon dioxide indicating nasal carriers. Viability of bacteria was shown to be affected by thermal effects. The percentages of particles that were viable bacteria at the different sizes were all found to be very low (<1%). PRACTICAL IMPLICATIONS: Due to their respiratory health effects, determining exposure to airborne viable bacteria and particles of different sizes requires the study of their behavior in relation to each other. This study attempts to characterize the relationships of bacteria and particles that are predominantly of human origin. Findings of this work will help researchers in understanding how bacteria levels co-exist with particles of corresponding aerodynamic size across different size ranges between 20 degrees and 26 degrees C.

Emission modelling and validation of VOCs' source strengths in air-conditioned office premises.

An emission model for indoor volatile organic compounds (VOCs) based on mass balance considerations has been presented and validated under steady state conditions. Comparison were made for the measured and predicted concentrations of 37 selected VOCs and TVOC through a case intervention study on the filters of the ventilation system in a new commercial air-conditioned office building. The intervention involved replacing media filters with electronic and carbon filtration. TVOC and 37 compounds selected for their health and comfort impact, representation of major chemical classes that occur in indoor air and their utility as markers of pollution sources were studied. The concentration levels predicted by the model were compared with actual measurements. Twenty-five target compounds and the TVOC were adequately described by the model where the measured concentrations were in agreement with the predicted concentrations. Modeling of the remaining 12 compounds was found to be affected by the emission rates that were occupant related.

Effects of temperature and outdoor air supply rate on the performance of call center operators in the tropics.

UNLABELLED: A study was performed in a call center that provides billing inquiry services using a 2 x 2 balanced experimental plan for nine consecutive weeks. Two independent variables, temperature and outdoor air supply rate, were combined and introduced to the occupants in a blind intervention approach. The temperature set-points were fixed at 22.5 degrees C and 24.5 degrees C, and outdoor air supply rate at 5 l /s/p and 10 l/s/p. Temperature and outdoor air supply rate had significant interaction effects on worker's talk time (P < 0.001), which means that the effects of temperature on talk time performance were not independent of the effects of outdoor air supply rate or the opposite. Talk time was reduced significantly when the outdoor air supply rate was increased from 5 l /s/p to 10 l/s/p at 24.5 degrees C (P < 0.01); this may be associated with the significant reduction in a principal component factor which includes intensity of dryness, aching eyes and nose-related symptoms (P < 0.01). Decreasing the temperature from 24.5 degrees C to 22.5 degrees C at 10 l /s/p significantly increased talk time (P < 0.01). Analysis of the principal component factor based on the neurobehavioral symptoms also revealed that temperature reduction led to an increased mean factor score of these symptoms (P < 0.04). PRACTICAL IMPLICATIONS: For moderately complex office work which involves manipulation dexterity such as a call center operation where call operators interact with computer-based information systems, tropically acclimatized workers' performance could be improved by increasing the outdoor air supply rate from 5 l/s/p to 10 l/s/p if the temperature is to be maintained at the higher band of the thermal comfort range, around 24.5 degrees C. At a low ventilation rate (5 l/s/p), decreasing the temperature from 24.5 degrees C to 22.5 degrees C (which is a commonly adopted set-point in tropical office buildings) also leads to improvement of talk time performance. The magnitude of talk time improvement was greater by more than four times when the strategy to increase the outdoor air supply rate was implemented at a lower range of outdoor air supply rate (5-10 l /s/p) as compared to the higher range (9.8-22.7 l/s/p).

Indoor air quality and energy performance of air-conditioned office buildings in Singapore.

An integrated indoor air quality (IAQ)-energy audit methodology has been developed in this study in Singapore, which provides a rigorous and systematic method of obtaining the status-quo assessment of an 'IAQ signature' in a building. The methodology entails a multi-disciplinary model in obtaining measured data pertaining to different dimensions within the built environment such as the physical, chemical, biological, ventilation, and occupant response characteristics. This paper describes the audit methodology and presents the findings from five air-conditioned office buildings in Singapore. The research has also led to the development of an indoor pollutant standard index (IPSI), which is discussed in this paper. Other performance indicators such as, the ventilation index and the energy index as well as the building symptom index (BSI) are also presented and discussed in the context of an integrated approach to IAQ and energy. Several correlation attempts were made on the various symptoms, indoor air acceptability, thermal comfort, BSI and IPSI, and while BSI values are found to correlate among them as well as with IAQ and THERMAL COMFORT acceptability, no such correlation was observed between BSI and IPSI. This would suggest that the occupants' perception of symptoms experienced as well as environmental acceptability is quite distinct from IAQ acceptability determined from empirical measurements of indoor pollutants, which reinforces the complex nature of IAQ issues.

A study of local electrostatic filtration and main pre-filtration on airborne and surface dust levels in air-conditioned office premises.

The impact of electrostatic precipitation as a useful form of particulate filtration in the breathing zone is investigated in an intervention study in an air-conditioned commercial office in central London. Surface dust deposition and airborne dust levels are measured in the open plan zones of two floors--a control floor and a floor where the intervention is effected. The intervention consists of a sequence of weekly scenarios where the main pre-filters of the air-handling unit are switched between new and old filters, and where the electrostatic filters, located as uniformly as practicable on the open plan areas, are switched on or off. This 2 x 2 set of interventions is repeated over 4 cycles. It was found that the breathing zone filtration (BZF) by electrostatic precipitators reduces airborne dust significantly and appears to be more efficient in reducing smaller sized particles. No significant effect of BZF filters in reducing surface dust deposition was detected.