Charles E. Feigley

Investigation of the Concentration of Bacteria and Their Cell Envelope Components in Indoor Air in Two Elementary Schools

ABSTRACT Bacterial cell envelope components are widely distributed in airborne dust, where they act as inflammatory agents causing respiratory symptoms. Measurements of these agents and other environmental factors are assessed in two elementary schools in a southeastern city in the United States. Muramic acid (MA) was used as a marker for bacterial peptidoglycan (PG), and 3-hydroxy fatty acids (3-OH FAs) were used as markers for Gram-negative bacterial lipopolysaccharide (LPS). Culturable bacteria were collected using an Andersen sampler with three different culture

Increased levels of bacterial markers and CO2 in occupied school rooms

Our group previously demonstrated that carbon dioxide (CO2) levels in heavily occupied schools correlate with the levels of airborne bacterial markers. Since CO2 is derived from the room occupants, it was hypothesized that in schools, bacterial markers may be primarily increased in indoor air because of the presence of children; directly from skin microflora or indirectly, by stirring up dust from carpets and other sources. The purpose of this project was to test the hypothesis. Muramic acid (Mur) is found in almost all bacteria whereas 3-hydroxy fatty acids (3-OH FAs) are found only in Gram-negative bacteria. Thus Mur and 3-OH FA serve as markers to assess bacterial levels in indoor air (pmol m(-3)). In our previous school studies, airborne dust was collected only from occupied rooms. However, in the present study, additional dust samples were collected from the same rooms each weekend when unoccupied. Samples were also collected from outside air. The levels of dust, Mur and C10:0, C12:0, C14:0, and C16:0 3-OH FAs were each much higher (range 5-50 fold) in occupied rooms than in unoccupied school rooms. Levels in outdoor air were much lower than that of indoor air from occupied classrooms and higher than the levels in the same rooms when unoccupied. The mean CO2 concentrations were around 420 parts per million (ppm) in unoccupied rooms and outside air; and they ranged from 1017 to 1736 ppm in occupied rooms, regularly exceeding 800-1000 ppm, which are the maximum levels indicative of adequate indoor ventilation. This indicates that the children were responsible for the increased levels of bacterial markers. However, the concentration of Mur in dust was also 6 fold higher in occupied rooms (115.5 versus 18.2 pmole mg(-1)). This further suggests that airborne dust present in occupied and unoccupied rooms is quite distinct. In conclusion in unoccupied rooms, the dust was of environmental origin but the children were the primary source in occupied rooms.

An experimental design approach to retrospective exposure assessment.

There are several methods currently in use for retrospective estimation of quantitative exposure levels in occupational and environmental epidemiologic studies. The most popular is a job-exposure matrix approach using a combination of existing data and professional judgment. Another method is the use of statistical models based on available exposure data. The authors present an alternative approach using an experimental design in which several factors thought to affect exposure levels are identified and set at specific levels in a cross-classified design. This approach was used to estimate historical exposures to formaldehyde in a mortality study of embalmers. Exposures were estimated as a function of solution concentration, air exchange rate, and autopsied versus intact body. There were 12 combinations involving these 3 factors and a total of 25 embalming procedures (approximately 2 replicates of each combination) performed at a college of mortuary science. In addition to these design factors several covariates such as temperature, humidity, and the occurrence of spills were considered in an analysis of covariance statistical model. The results of the model prediction were validated against published measurements, and field samples were taken in several funeral homes. The overall accuracy of the model predictions was comparable to the variation found in replicate measurements of identical embalming procedures.

Study Design for Assessing Exposures of Embalmers for a Case-Control Study. Part I. Monitoring Results

Abstract Epidemiologic studies of embalmers and funeral directors have found excess risks of mortality due to leukemia and brain cancer. To investigate specific occupational exposures that might account for these associations, a case-control study of these diseases among embalmers is under way. To quantify exposure levels for this study, a series of embalmings was performed using an experimental design to determine the effect of certain work parameters on the concentration of airborne contaminants. Personal exposures and area concentrations of formaldehyde, methanol, phenol, and particulates were measured during 25 embalmings while controlling the level of ventilation, the concentration of the embalming solution, and the type of case (autopsy or intact body). In addition, bischloromethyl ether (BCME) and selected microorganisms (total, fungi, and bacteria) were measured during a few embalmings. Personal formaldehyde exposures ranged from 0.31 to 8.72 parts per million (ppm) for full-period exposures (51-1...

The Effect of Worker's Location, Orientation, and Activity on Exposure

The impact of a workers location, orientation, and activity was studied in an experimental room (2.86 m × 2.35 m × 2.86 m) at known flow rates of 5.5 m 3 /min and 3.3 m 3 /min. A person in the room, wearing a full-facepiece, air-supplied respirator represented a worker. Propylene tracer gas was emitted at a constant rate from a 1-m pedestal at the center of the room and a continuous air sample was drawn from a point midway between the workers mouth and nose. Breathing zone concentration (BZC) was monitored at 12 worker locations within the room for a stationary worker. At each location, BZCs were measured separately for four worker orientations: east, west, south, and north. BZCs of a walking worker were also monitored along the path defined by the 12 worker locations used in the stationary experiments. In a separate set of experiments, area concentration was monitored to see whether the workers activity disturbed the contaminant concentrations at a fixed sampling point located behind the source looking from the direction of air inlet (location: 1.34 m, 1.20 m, 0.45 m). The following average differences in BZC over the 12 fixed locations were observed: 43% higher for near-field than for far-field locations; 20% higher when the worker was facing the source than when facing away (p-values for all four conditions: < 0.033), and 30% higher for a moving worker than for a stationary worker (p-values for all four conditions: < 0.01). When the worker was walking, the concentration at the fixed area sampling point was generally lower than the area concentration when the worker was absent or stationary in the room, possibly due to greater mixing of room air by the workers movement. Because a workers activities may be irregular and complicated, incorporating them as parameters in mathematical models is often not feasible. Instead, these findings may be used to assess uncertainty or adjust exposure estimates from simple models.

Coastal terrorism: using tabletop discussions to enhance coastal community infrastructure through relationship building.

The unique vulnerability of the nations ports to terrorist attacks and other major disasters requires development of specialized training approaches that integrate and connect critical stakeholders. In 2003, the University of South Carolina Center for Public Health Preparedness developed and held its first Coastal Terrorism workshop in conjunction with the National Oceanic and Atmospheric Administration. Key federal, regional, state, and coastal agency leaders were invited to the 2-day event to explore, in a no-risk environment, the crucial role that public health agencies would play in a covert biological agent incident aboard a cruise ship. The incident began as a possible outbreak of a Norwalk-like viral agent; however, as the scenario unfolded, evidence of a terrorist plot emerged. This immediately shifted the scenario from a public health-dominated incident to one directed by law enforcement. Communication and coordination issues surfaced illustrating potential conflicts between disciplines and jurisdictions in terms of roles and responsibilities of responding agencies. The goals of the workshop were to facilitate communication and interagency networking among coastal stakeholders while assessing their training and research needs and increasing their familiarity with resources and protocols regarding a bioterrorist coastal event. Positive systems changes were observed.

Emergency preparedness academy adds public health to readiness equation.

From November 2003 to May 2004, the University of South Carolina Center for Public Health Preparedness and the South Carolina Department of Health and Environmental Control co-sponsored a 6-month-long Academy for Public Health Emergency Preparedness. Six-member teams made up of public health staff and community partner representatives (N = 78) attended from their respective health districts. The Academy consisted of three 6-day training sessions designed to prepare the teams to complete a team-based covert biological bioterrorism tabletop exercise. Program evaluation results revealed increases in (1) public health emergency preparedness core competencies; (2) capacity to plan, implement, and evaluate a tabletop exercise; and (3) successful collaboration and partnership formation between participating Public Health District teams and their local partner agencies. Lessons learned are also described.

Improving the use of mixing factors for dilution ventilation design

In specifying dilution ventilation flow rate, a safety factor, K, is often used to provide a margin of safety and to compensate for uncertainties and health impact severity. In current practice, the selection of K is very subjective. Here the component of K accounting for imperfect mixing, Km, was studied to develop more effective and efficient design procedures. Air flow and contaminant distribution in a 10 m x 3 m x 7 m room with a single contaminant source on a 1-m high table were simulated for steady, isothermal conditions using computational fluid dynamics. A series of 10 simulations explored factorial combinations of air exchange rates (1, 2,4, 8, 16 ACH) and inlet types (a high wall jet and a ceiling diffuser). Nine additional simulations explored exhaust opening location effects and 13 other simulations investigated source location effects. Km was calculated at each of 25,600 grid locations within the room by linear regression of emission rate/flow rate (G/Q) on concentration (C). The linear relationship between C and G/Q at each of the points was nearly perfect (R2 > 0.97). For the simulations with varying dilution flow rate, Km ranged from 0.19 to 2.86 for the wall jet and from 0.94 to 4.34 for the ceiling diffuser. Holding G/Q at 100 ppm and varying source and exhaust location produced room average concentrations from 55.7 to 173 ppm. Unlike orthodox design approaches, this work suggests that air monitoring data often can be used to calculate dilution flow rate requirements. Also, dilution flow rate requirements may be reduced by enhancing room mixing with fans or altering air inlet configuration. However, mixing should not be increased if the altered room air currents could transport contaminant to an occupants breathing zone or interfere with other control methods that depend on segregation of incoming air and contaminant.

MODELING AN IRRITANT GAS PLUME FOR EPIDEMIOLOGIC STUDY

Plume dispersion modeling systems are often used in assessing human exposures to chemical hazards for epidemiologic study. We modeled the 2005 Graniteville, South Carolina, 54,915 kg railcar chlorine release using both the Areal Locations of Hazardous Atmospheres and Hazard Prediction and Assessment Capability (HPAC) plume modeling systems. We estimated the release rate by an engineering analysis combining semi-quantitative observations and fundamental physical principles. The use of regional meteorological conditions was validated by comparing concentration estimates generated by two source-location weather data-sets. The HPAC model estimated a chlorine plume with 20 ppm outdoor concentrations up to 7 km downwind and 0.25 km upwind/downgrade. A comparative analysis of our two models showed that HPAC was the best candidate for use as a model system on which epidemiologic studies could be based after further model validation. Further validation studies are needed before individual exposure estimates can be reliable and the chlorine plume more definitively modeled.

Scale and shape issues in focused cluster power for count data

BackgroundInterest in the development of statistical methods for disease cluster detection has experienced rapid growth in recent years. Evaluations of statistical power provide important information for the selection of an appropriate statistical method in environmentally-related disease cluster investigations. Published power evaluations have not yet addressed the use of models for focused cluster detection and have not fully investigated the issues of disease cluster scale and shape. As meteorological and other factors can impact the dispersion of environmental toxicants, it follows that environmental exposures and associated diseases can be dispersed in a variety of spatial patterns. This study simulates disease clusters in a variety of shapes and scales around a centrally located single pollution source. We evaluate the power of a range of focused cluster tests and generalized linear models to detect these various cluster shapes and scales for count data.ResultsIn general, the power of hypothesis tests and models to detect focused clusters improved when the test or model included parameters specific to the shape of cluster being examined (i.e. inclusion of a function for direction improved power of models to detect clustering with an angular effect). However, power to detect clusters where the risk peaked and then declined was limited.ConclusionFindings from this investigation show sizeable changes in power according to the scale and shape of the cluster and the test or model applied. These findings demonstrate the importance of selecting a test or model with functions appropriate to detect the spatial pattern of the disease cluster.