Mechanistic hypotheses about airborne infectious disease transmission have traditionally emphasized the role of coughing and sneezing, which are dramatic expiratory events that yield both easily visible droplets and large quantities of particles too small to see by eye. Nonetheless, it has long been known that normal speech also yields large quantities of particles that are too small to see by eye, but are large enough to carry a variety of communicable respiratory pathogens. Here we show that the rate of particle emission during normal human speech is positively correlated with the loudness (amplitude) of vocalization, ranging from approximately 1 to 50 particles per second (0.06 to 3 particles per cm3) for low to high amplitudes, regardless of the language spoken (English, Spanish, Mandarin, or Arabic). Furthermore, a small fraction of individuals behaves as "speech superemitters," consistently releasing an order of magnitude more particles than their peers. Our data demonstrate that the phenomenon of speech superemission cannot be fully explained either by the phonic structures or the amplitude of the speech. These results suggest that other unknown physiological factors, varying dramatically among individuals, could affect the probability of respiratory infectious disease transmission, and also help explain the existence of superspreaders who are disproportionately responsible for outbreaks of airborne infectious disease.

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Aerosol emission and superemission during human speech increase with voice loudness

a time as one year after leaving the Rehabilitation Unit, and about one quarter were not in competitive jobs but were in sheltered employment. Only just over one quarter were still working in ordinary jobs. Their average wage was £8 I is. 6d. Furthermore if one compares the type of work these patients were able to perform there was a definite decline from their premorbid position. The social class grouping before and after rehabilitation was Class II, i-i, Class III, 9-3, Class IV, 4-6, and Class V, IO-I4. Indeed the authors report that 'even the least handicapped of these patients presented continuous problems . . .' and it is noted that such a programme requires special personnel and a great deal of work. Comparing these results with the extra cost in personnel, time, and effort (which could be directed elsewhere) a Doctor Beeching of the psychiatric services would probably scrap such a rehabilitation service before it even started. But is this the right way of looking at it? The authors point out that such a programme, if applied throughout the country, would affect about 6,ooo patients. If the failure rate were the same as in this experiment, about I,500 would be rescued from a disabled life in a mental hospital and once more returned to an at least partially useful and, one assumes, more satisfying life. Obviously more is involved here than mere economics. We were interested to read that as regards behaviour at the Rehabilitation Centre and during the follow-up year 'There were no outstanding differences' between the schizophrenic and the non-schizophrenic rehabilitees. It appears that the group of schizophrenics had difficulties in social adjustment which were even greater than those of work adjustment. '. . . the men concerned had greater difficulty in living outside hospital, than in working outside hospital. If, however, adequate arrangements are made to cater for these various needs, there seems to be every reason to expect that a small selected group of long stay schizophrenic patients can be successfully resettled in work.' The experiment and the report show the high standards we have come so confidently to expect from Dr. Wing and his colleagues, and the publication will be read with interest, not only by psychiatrists, but by all those concemed with rehabilitation problems of chronically disabled patients. J. HOENIG

https://oem.bmj.com/content/oemed/23/2/161.2.full.pdf

The Mechanics of Aerosols

Airflows in the nasal cavities and oral airways are rather complex, possibly featuring a transition to turbulent jet-like flow, recirculating flow, Dean's flow, vortical flows, large pressure drops, prevailing secondary flows, and merging streams in the case of exhalation. Such complex flows propagate subsequently into the tracheobronchial airways. The underlying assumptions for particle transport and deposition are that the aerosols are spherical, noninteracting, and monodisperse and deposit upon contact with the airway surface. Such dilute particle suspensions are typically modeled with the Euler-Lagrange approach for micron particles and in the Euler-Euler framework for nanoparticles. Micron particles deposit nonuniformly with very high concentrations at some local sites (e.g., carinal ridges of large bronchial airways). In contrast, nanomaterial almost coats the airway surfaces, which has implications of detrimental health effects in the case of inhaled toxic nanoparticles. Geometric airway features, ...

Airflow and Particle Transport in the Human Respiratory System

fine particle hypothesis stating that ambient ultrafine particles (UFP; < 0.1 μm in aerodynamic diameter) may cause adverse health effects at the first Colloquium for Particulate Air Pollution and Human Mortality and Morbidity in Irvine, California, it was met with friendly skepticism as well as out-right dismissal. Arguments were that UFP are very short-lived and disappear through heterogeneous and homogeneous aggregation within seconds or minutes and therefore are toxicologically irrelevant. These arguments did not recognize that UFP are continuously generated or that ambient UFP contribute very little, if any, mass to ambient PM10 (particles < 10 μm in aerodynamic diameter) or PM2.5 (particles < 2.5 μm in aerodynamic diameter). Indeed, the mass distribution of a typical urban aerosol among the different particle sizes may support this point (Figure 1). This attitude of skepticism has changed considerably. Research teams across the world are working now on UFP, forming multidisciplinary alliances between atmospheric scientists, engineers, epidemiologists, clinicians, and toxicologists. They investigate UFP sources, generation, physicochemical characteristics, behavior in ambient air, and potential effects and underlying mechanisms following their inhalation. Still, sound skepticism lingers, as demonstrated by the title of a presentation at the 2002 meeting of the Health Effects Institute: “Nanoparticles: Are They Real?” Obviously, there is no question that UFP are real, but it is also clear that we still do not know enough about them, despite significant progress in our understanding since 1994. Atmospheric UFP derived from gas-to-particle conversions have many sources, natural and anthropogenic, the latter being mostly derived from internal combustion processes. Diesel fuel, gasoline, and even compressed natural gas—considered to be “clean”—powered engines all emit high numbers of UFP. If these anthropogenic UFP cause significant health effects, is the conversion of dieselpowered buses to compressed natural gas—as practiced now in several cities—really a good idea? We should be more cautious about introducing technologies based on the assumption that they result in cleaner air with fewer and less toxic contaminants. The experience with methyl tert-butyl ether as a fuel additive should serve as a reminder of the potential unintended health and environmental consequences of altering fuels and resulting emissions on a large scale without an adequate understanding of toxicity. Since vehicular emissions are regulated by mass output, modern technologies for internal combustion engines favor the generation and formation of UFP because they contribute minimally to the mass output of fine particles (Figure 1). It should come as no surprise that “clean” engines are built to conform to present standards of mass output, despite emitting high numbers of UFP. A standard based on particle number would be more appropriate to reduce UFP emissions. A standard based on particle surface area—as is also proposed—may not be helpful to control UFP because fine particles comprise most of the total particle surface area (Figure 1). In recent measurements made during road-chase studies in Minnesota, UFP concentrations were as high as 1 × 107 particles/cm3 (Kittelson et al. 2001). A short distance from the highways, these high UFP concentrations are lower, but individuals in automobiles on the highways are directly exposed to the high concentrations. Moreover, these UFP are freshly generated, and if results of earlier toxicologic studies with UFP generated from thermodegradation products of polymers are an indication of a general principle of UFP toxicity, freshness and proximity to the source are key requirements for inducing acute adverse effects of UFP. Do UFP emitted from internal combustion engines cause adverse health effects? We still need to know more, but results from our controlled clinical and animal studies using ultrafine elemental carbon particles permit some preliminary conclusions: The high deposition of inhaled UFP (0.007–0.1 μm) in the human respiratory tract as predicted by ICRP (1994) could be confirmed; moreover, deposition was even higher during exercise and in asthmatics. Unlike larger fine particles, UFP seem to escape phagocytosis by alveolar macrophages and are translocated to extrapulmonary organs, as was determined in rodents using ultrafine 13C particles, although such translocation was only minimal with ultrafine iridium particles. Cardiovascular effects in humans and animals and mild pulmonary inflammation in animals were also found following ultrafine carbon particle exposures. Although health effects data and understanding of mechanisms are still limited, there are intriguing data from other disciplines, in particular the field of drug delivery: Intravenously administered UFP were found to cross the blood–brain barrier (Kreuter, 2001), and a transport function of caveolae for macromolecules with molecular radii of several

Ultrafine Particles in the Urban Air: To the Respiratory Tract-And beyond? Is the Central Nervous System Yet Another Target for Ultrafine Particles? (Editorial)

Humidity: A review and primer on atmospheric moisture and human health.

A number of in vivo, in vitro and numerical studies have considered flow field characteristics and micro-particle deposition in the oral airway extending from the mouth through the larynx. These studies have highlighted the effects of flow rates, turbulence and particle characteristics on deposition values in realistic and simplified geometries. However, the effect of geometry simplifications on regional and local deposition patterns remains largely un-quantified for the oral airway and throughout the respiratory tract. The objective of this study is to assess the effects of geometry simplifications on regionally averaged and local micro-aerosol deposition characteristics in models of the extrathoracic oral airway. To achieve this objective, a realistic model of the oral airway has been constructed based on CT scans of a healthy adult in conjunction with measurements reported in the literature. Three other geometries with descending degrees of physical realism were constructed based on successive geometric simplifications of the realistic model. A validated low Reynolds number (LRN) k-omega turbulence model was employed to simulate laminar, transitional and fully turbulent flow regimes for 1-31 microm particles. Geometric simplifications were found to have a significant effect on aerosol dynamics, hot spot formations and cellular-level deposition values in the extrathoracic airway models considered. For all models, regional deposition efficiency results were found to be approximately within one standard deviation of available experimental data when plotted as a function of Stokes number. The realistic geometry provided the best predictions of regional deposition in comparison to experimental data as a function of particle diameter. Considering localized deposition, maximum deposition enhancement factors, which represent the ratio of local to total deposition, were one to two orders of magnitude higher for the realistic model. Geometric factors that significantly contributed to enhanced particle localization in the realistic model include a triangular-shaped glottis and a dorsal-sloped trachea. Therefore, highly realistic models of the oral airway geometry may be necessary to evaluate localized deposition patterns and hot spot formations, which are critical for accurately predicting cellular-level dose.

Transport and Deposition of Micro-Aerosols in Realistic and Simplified Models of the Oral Airway

Direct Lagrangian particle tracking may provide an effective method for simulating the deposition of ultrafine aerosols in the upper respiratory airways that can account for finite inertia and slip correction effects. However, use of the Lagrangian approach for simulating ultrafine aerosols has been limited due to computational cost and numerical difficulties. The objective of this study is to evaluate the effectiveness of direct Lagrangian tracking methods for calculating ultrafine aerosol transport and deposition in flow fields consistent with the upper respiratory tract. Representative geometries that have been considered include a straight tubular flow field, a 90° tubular bend, and an idealized replica of the human oral airway. The Lagrangian particle tracking algorithms considered include the Fluent Brownian motion (BM) routine, a user-defined BM model, and a user-defined BM model in conjunction with a near-wall interpolation (NWI) algorithm. Lagrangian deposition results have been compared with a c...

Effectiveness of Direct Lagrangian Tracking Models for Simulating Nanoparticle Deposition in the Upper Airways

The extent to which laryngeal-induced flow features penetrate into the upper tracheobronchial (TB) airways and their related impact on particle transport and deposition are not well understood. The objective of this study was to evaluate the effects of including the laryngeal jet on the behavior and fate of inhaled aerosols in an approximate model of the upper TB region. The upper TB model was based on a simplified numerical reproduction of a replica cast geometry used in previous in vitro deposition experiments that extended to the sixth respiratory generation along some paths. Simulations with and without an approximate larynx were performed. Particle sizes ranging from 2.5 nm to 12 mum were considered using a well-tested Lagrangian tracking model. The model larynx was observed to significantly affect flow dynamics, including a laryngeal jet skewed toward the right wall of the trachea and a significant reverse flow in the left region of the trachea. Inclusion of the laryngeal model increased the tracheal deposition of nano- and micrometer particles by factors ranging from 2 to 10 and significantly reduced deposition in the first three bronchi of the model. Considering localized conditions, inclusion of the laryngeal approximation decreased deposition at the main carina and produced a maximum in local surface deposition density in the lobar-to-segmental bifurcations (G2-G3) for both 40-nm and 4-microm aerosols. These findings corroborate previous experiments and highlight the need to include a laryngeal representation in future computational and in vitro models of the TB region.

Effects of the laryngeal jet on nano- and microparticle transport and deposition in an approximate model of the upper tracheobronchial airways

Numerical predictions of submicrometer aerosol deposition in the nasal cavity using a novel drift flux approach

Previous experimental studies have shown that concentrated cigarette smoke particles (CSPs) deposit in the upper airways like much larger 6 to 7 μ m aerosols. Based on the frequent assumption that relative humidity (RH) in the lungs does not exceed approximately 99.5%, the hygroscopic growth of initially submicrometer CSPs is expected to be a relatively minor factor. However, the inhalation of mainstream smoke may result in humidity values ranging from sub-saturated through supersaturated conditions. The objective of this study is to evaluate the effect of condensation particle growth on the transport and deposition of CSPs in the upper respiratory tract under various RH and temperature conditions. To achieve this objective, a computational model of transport in the continuous phase surrounding a CSP was developed for a multicomponent aerosol consisting of water soluble and insoluble species. To evaluate the transport and deposition of dilute hygroscopic CSPs in the upper airways, a model of the human mou...

https://www.tandfonline.com/doi/pdf/10.1080/02786820802232964

Jinxiang Xi

Papers

Transport and Deposition of Micro-Aerosols in Realistic and Simplified Models of the Oral Airway

Effectiveness of Direct Lagrangian Tracking Models for Simulating Nanoparticle Deposition in the Upper Airways

Effects of the laryngeal jet on nano- and microparticle transport and deposition in an approximate model of the upper tracheobronchial airways

Numerical predictions of submicrometer aerosol deposition in the nasal cavity using a novel drift flux approach

Condensational Growth May Contribute to the Enhanced Deposition of Cigarette Smoke Particles in the Upper Respiratory Tract