\r\n\tHydroxyapatite (HA) is an important member of the calcium phosphate chemical family. It has been used in several medical applications for the past decades, due to its chemical similarity to the mineral phase of bone and high biocompatibility. Several studies demonstrated that bone mineral presents several ion substitutions, so in order to prepare a synthetic material with an even closer composition to bone mineral, HA has been prepared with the incorporation of several ions like, silicon or fluoride. These ions induced not only structural changes on HA lattice, but also on its biocompatibility. \r\n\tSignificant advances in nanotechnologies resulted in the preparation of HA in different forms, with a wider range of applications, from support to drug and gene delivery. \r\n\tThis book aims to collect the most relevant information regarding HA properties, modifications and its application in the biomedical field.
",isbn:null,printIsbn:"979-953-307-X-X",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"6a3c2d529bd0b7fb6d259f00b4562d77",bookSignature:"Dr. Claudia Manuela da Cunha Ferreira Botelho",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/8199.jpg",keywords:"Apatite, Chemical and Physical Structure, Hydrothermal Synthesis, Synthesis from Biogenic Sources, Mineralization, Bone Structure, Vascularization, Resorption, Silicon, Improved Bioactivity,Bone Substitute, Drug and Gene Carrier",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 4th 2019",dateEndSecondStepPublish:"February 17th 2020",dateEndThirdStepPublish:"April 17th 2020",dateEndFourthStepPublish:"July 6th 2020",dateEndFifthStepPublish:"September 4th 2020",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"2 years",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:null,coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"258963",title:"Dr.",name:"Claudia Manuela",middleName:null,surname:"Da Cunha Ferreira Botelho",slug:"claudia-manuela-da-cunha-ferreira-botelho",fullName:"Claudia Manuela Da Cunha Ferreira Botelho",profilePictureURL:"https://mts.intechopen.com/storage/users/258963/images/system/258963.jpg",biography:"Claudia Botelho obtained a PhD in Science Engineering from Porto University, Portugal, in 2005. 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1. Introduction
Air and surface sampling was conducted to confirm the types of microbiological contamination within a hospital facility in the southern United States, identify indicators of indoor microbiological contamination, and profile the aero-biological makeup of the inside air (ISA) for comparisons to outside air (OSA) and reference concentrations, where applicable. The investigation strategy recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) was utilized to assess indoor environmental quality and conditions found within the hospital facility. The ACGIH methodology is guided by the text Bioaerosols: Assessment and Control. (Macher 1999) Biological contamination within a hospital environment is of great concern as bacteria and fungi are important causes of nosocomial infection (NI). It is estimated that the overall hospital-acquired infection rate in Europe and North America is between 5 and 10%. (Kalliokoski 2003) A substantial number of bacteria and fungi are capable of spreading via the airborne route in hospitals, and airborne transmission accounts for approximately 10% of all NI. (Eickhoff 1994; Kalliokoski 2003) Contaminated Heating, Ventilating, and Air Conditioning (HVAC) systems and infiltration of unfiltered outside air have been implicated in airborne outbreaks of NI via infective aerosols, dust, and contaminated filters. (Lentino, Rosenkranz et al. 1982; Rhame 1991; Eickhoff 1994) Certain underlying diseases, procedures, hospital services, and categories of age, sex, race, and urgency of admission have been shown to be significant risk factors for nosocomial infection. (Freeman and McGowan 1978) The day-specific incidence of nosocomial infection rises from near zero on the first hospital day to maximal during the fourth through seventh weeks of hospital stay. (Freeman and McGowan 1981) Nosocomial infections can affect patients in any location within a hospital. (Boss and Day 2003)
The Centers for Disease Control (CDC) estimates that 2 million patients develop hospital-acquired infections annually and as many as 88,000 die as a result. (CDC 1992) Hospitals typically maintain a patient population with increased susceptibility to infection and factors inherent to the healthcare environment contribute to the risk associated with acquiring an infection during a hospital admission. (Dulworth and Pyenson 2004) Environmental control and high efficiency filtration are critical to preventing person-to-person and environmentally related infections in hospitals. (Wenzel 1997; Boss and Day 2003) Current evidence indicates that excessive moisture indoors promotes microbial growth and is associated with an increased prevalence of symptoms due to irritation, allergy, and infection. It is widely accepted in various scientific communities that indoor microbiological contamination presents unacceptable conditions for the preservation of human health, and that removal and prevention of microbial contamination is necessary and prudent. (Pope, Patterson et al. 1993; Macher 1999; Agency 2001; ACOEM 2002; Fung and Hughson 2002; Redd 2002; CDC 2003; Fung and Hughson 2003)
The inherent variability of microbiological organisms in air presents a challenge for conducting air sampling that provides meaningful results for the evaluation of human exposure and health risk. In general, bioaerosol air sampling is highly variable and prone to error. Multiple and replicate samples over subsequent days are necessary to characterize exposure and multiple samples per sample location are required to evaluate human exposure in that particular location. An air and surface sampling plan was designed to address the inherent variability and error associated with air sampling and to evaluate the exposure and subsequent health risk to patients, visitors, and staff in a hospital facility. The objectives of this chapter are to highlight the necessity for multiple (replicate) air samples per sample location to conduct valid assessments of the airborne concentrations of bioaerosols.
2. Materials and methods
Sampling was conducted to provide a bioaerosol profile of the air within the spaces under the control of 9 separate HVAC systems over a two-year period. The spaces under the environmental control or each HVAC system are identified as air handling units (AHUs) 10, 11 (no final filters present), 13 (90% final filters), 15, 16, 17, 18, and 19 during the summer of 2005. In early 2006, a follow-up investigation was conducted within the spaces controlled by AHUs 17, 19, and 21. Except where indicated, AHU final filters had a filtration efficiency of 95%. Air and surface sampling data and analysis, observations, and the collective experience of a team experienced in moisture intrusion in hospital facilities along with input from professionals in medical microbiology, industrial hygiene, medicine, engineering, and public health were utilized to interpret data for hypothesis testing. The hypotheses were:
Hypothesis A: The 90-95% final filters control particulate matter generated by the AHUs and preventing contamination downstream of the filters. Note: AHU 11 does not have final filters and therefore this hypothesis does not apply to AHU 11.
Hypothesis B: The 90-95% final filters prevent microbial contamination downstream of the filters. Note: AHU 11 does not have final filters and therefore this hypothesis does not apply to AHU 11.
Hypothesis D: Staff is being exposed to potentially harmful concentrations of biological contaminants.
Hypothesis E: Patients are being exposed to harmful quantities of biological contaminants.
Air sampling was conducted to establish mean airborne concentrations of fungal and biological aerosols indoors and outdoors to characterize the fungal and bacterial aerobiological profiles of the areas controlled by each AHU. Culturable air samples were analyzed at the species level as information on species is crucial for determining whether indicator organisms are present. Indicator species of fungi whose presence indicates excessive indoor moisture or a health hazard were evaluated. Indicator organisms identified via air sampling in the hospital were Aspergillus versicolor,\n\t\t\t\tA. flavus, A. fumigatus, Fusarium species, yeasts, and species of Penicillium. (Macher 1999) In addition, the American Industrial Hygiene Association (AIHA) has consistently recommended urgent risk management decisions be made when the confirmed presence of these indicator organisms are identified indoors These indicator organisms include those listed above in addition to Stachybotrys\n\t\t\t\tchartarum. The confirmed presence is defined as colonies in several samples, many colonies in any sample, or, where a single colony was found in a single sample, evidence of growth of these fungi on building materials by visual inspection or source sampling. (Macher 1999) As early as 1996, AIHA stated that urgent risk management decisions are required of the industrial hygienist in the following conditions: a) the confirmed presence of facultative pathogens (fungi capable of inducing pulmonary infections in humans) such as A. versicolor and Fusarium moniliforme, and b) The presence of fungi, such as S. chartarum and F. moniliforme, known to result in occupational diseases in part due to their potent toxins. AIHA recommended that these urgent risk management decisions be made promptly as opposed to weeks or months later. (Dillon, Heinsohn et al. 1996; Prezant, Weekes et al. 2008) Based on the literature and in consideration of the recommendations made elsewhere by governmental and nongovernmental entities and other professional societies, the 1996 and 2008 AIHA recommendations and the 1999 ACGIH recommendations (Macher 1999) continue to be appropriate risk management guidance for the industrial hygienist and indoor environmental professional.
The estimated cumulative sampling and analytical error for each air sample is defined as EC = (P2 + T2 + A2 + O2)1/2 where EC is the cumulative error, P is the pump error (estimated at ± 5%), T is the time error (estimated at ± 2.5%), A is the analytical error (estimated to be ± 25%), and O is other error associated with calibration and technician variability (estimated to be ± 25%). (Macher 1999; Burton 2006) Solving for EC, the cumulative sampling and analytical error for each sample is estimated to be approximately ± 36%. Therefore, data derived from individual samples should be viewed as qualitative. The inherent variability of the air concentrations of bioaerosols over time or within a space far outweighs any errors associated with measurement of airborne microbiological concentrations. Thus, the interpretation of a single sample is difficult without information on the variability of the concentrations of biological agents identified in the environment because the variability in the measurement is almost always large. (Macher 1999)
Duplicate, side-by-side air samples were taken at each location to address the error associated with individual samples. Duplicate side-by-side air sampling is considered adequate to define the mean and the random sampling error given the high temporal and spatial variability of bioaerosol concentrations in air. (Dillon, Heinsohn et al. 1996) Multiple samples from multiple random and non-random locations were taken on separate days to characterize exposures within the space under the environmental control of each air handling unit. (Macher 1999) Replicate samples within the space controlled by each air handling unit were taken to address sampling variability (Weber and Page 2001) and allow for the estimation of the sampling data’s variances so that differences between two environments (e.g. ISA v. OSA concentrations) could be identified. (Macher 1999) A minimum of 6 replicate samples were taken at 10 indoor locations (6 ≤ n ≤ 48 samples per location) and 2 outdoor locations (12 ≤ n ≤ 72 total outdoor reference samples per indoor location). An ANOVA was utilized to compare indoor and outdoor concentrations of biological agents using SAS Statistical Software. The level of significance was prescribed as α = 0.05. A significant difference identified by the ANOVA indicates that the difference is unlikely to have occurred by chance and that there is statistical evidence that there is a difference. At the α = 0.05 (5%) level of significance, the result could have occurred by chance one time in 20. Statistical techniques evaluate an observed difference in view of its precision to determine with what probability it might have arisen by chance (the level of significance). Values with a low probability of occurring by chance are called statistically significant and are considered to represent a real effect (e.g. difference between means). (Conover 1999; Montgomery 2001)
Ideally, human respiratory exposure is measured using air samples taken near the breathing zone, or within 12 inches of the mouth. This was not feasible considering the large size and weight of bioaerosol air sampling equipment. Most bioaerosol sampling is done to characterize ambient aerosols and the ambient conditions are utilized as quantitative estimates of bioaerosol exposure. Although the characterization of the ambient environment is not the ideal exposure sampling scheme, when low flow rate suction impactors (e.g. Andersen type) are utilized, the error introduced is small. (Pope, Patterson et al. 1993) Low flow rate suction impactors were utilized to take bioaerosol samples.
A comparison of total fungal or bacterial concentrations may be used as a preliminary indicator of a difference in two environments, but not as evidence of similarity or dissimilarity. Indoor/outdoor comparisons are used to document the presence or infer the absence of indoor, biologically derived contamination. These comparisons cannot be made unless the genera and species found indoors and outdoors have been identified. (Macher 1999) Air sampling mean total counts were utilized as a preliminary indicator of a difference in two environments (e.g. indoor vs. outdoor air concentrations) to determine the effectiveness of the filters in removing aerobiological particulates from the air stream. Air sampling indicators of indoor microbiological contamination were identified from sampling results where both the genera and species are identified (culturable fungal and bacterial samples incubated at 25°C and 37°C). Culturable air samples were taken for incubation at two separate temperatures (25°C and 37°C) to enhance the detection of both environmental and pathogenic microorganisms in the air. (Dillon, Heinsohn et al. 1996; Macher 1999)
Air sampling indicators of indoor contamination were compared to both surface sampling results and outdoor air sampling concentrations of like-organisms for interpretation. Note that monitoring for allergens can help characterize environments with respect to specific allergens (e.g., fungi and/or bacteria), and measurements can be semi-quantitative (e.g., “presence or absence” or “low, medium, or high”). (Pope, Patterson et al. 1993) Airborne bioaerosol sampling was conducted so that comparisons and interpretations could be made between ISA and OSA culturable and non-culturable bioaerosols, mean concentrations and variability of concentrations, and species could be compared. Each set or type of sampling results should be viewed in consideration with the other sampling results and not independently. For example, one should not consider spore trap (total and non-culturable fungal samples) alone, as spore trap sampling does not identify fungi at the species level and may mask important differences in species present between test and reference locations. Analysis of spore traps alone or total fungal or bacterial concentrations could lead to incorrect conclusions. The sampling interpretation considered all sampling results for the development of interpretations and conclusions.
The American Society for Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) defines critical care areas as the following functional spaces within a hospital: 1) Surgery and Critical Care, 2) Nursing, 3) Ancillary, 4) Diagnostic and Treatment, and 5) Sterilization and Supply. Critical care areas include but are not limited to intensive care units, coronary care units, angiography laboratories, cardiac catheterization laboratories, delivery rooms, operating rooms, recovery rooms, emergency departments, and other special care units where enhanced engineering controls are required for the protection of patients and staff. Although patients spend most of their time within a specific area, they may be exposed to bioaerosols in non-critical locations of a hospital where engineering controls are not as stringent. Non-critical functional areas are administration and service locations within the Hospital. (ASHRAE 2003) Table 1 lists the critical and non critical locations within the areas investigated.
1st Floor, Administration Area, Labor and Delivery, Recovery, C-Section Room, Pre-Op Area, Intensive Care, Rehabilitation
Yes
21
Radiology, Purchasing, Shipping and Receiving, Plant Operations
Yes
Table 1.
Classification of Hospital areas by critical or non-critical area.
3. Results
3.1. Total outside vs. total indoor concentrations (2005 data)
Figure 1 depicts the percent difference of bioaerosols from the OSA reference concentrations to the ISA concentrations for the space controlled by each AHU. The results show that the existing filters within the facility were removing bioaerosols from the air within the Hospital.
95% final filters were installed in the AHUs investigated, with the exception of AHUs 11 and 13. AHU 11 did not have final filters and AHU 13 had 90% final filters installed. Ninety-five percent final filters are rated to remove greater than 90% of particles between 1.0 and 10 micrometers in size and 85-95% of particles between 0.3 and 1.0 micrometers in size. Ninety percent final filters are rated to remove 90% of particulate matter between 1 and 10 micrometers in size and 75-85% of particles between 0.3 and 1.0 micrometers in size.
Figure 1.
AHU percent differences from outside air to inside air. Note: A negative percent difference indicates that the indoor concentration was higher than outdoors.
(ASHRAE 1992; ASHRAE 1999) Therefore, with the exception of AHU 11, the percent differences for fungal particulates between OSA and ISA should approach 90% for organic (e.g. fungi and bacteria) particulate matter ranging from 1.0 to 10 micrometers in aerodynamic diameter and 78-85% of organic matter for particles ranging from 0.3-1.0 micrometers in aerodynamic diameter.
Non-culturable fungal air sampling via spore trap measures the airborne fungal particle concentrations in spores/m3 of air. The minimum percent difference (reduction) of 79% (AHU 19) for total spore count (spore trap) results indicates that at least 79% of the non-culturable total spore concentrations from the outside air are being removed by the HVAC systems prior to entering the building. The minimum percent difference of all fungal air sampling results is 63% for the fungal samples incubated at 25°C in the space controlled by AHU 11. Excluding AHU 11 because it does not have final filters, the minimum percent difference of all fungal sampling results is 66% for AHU 13, which has 90% final filters. This indicates that at least 66% of the fungal bioaerosols are being removed by the final filters of the AHUs investigated, with the exception of AHU 11. The concentrations of total and culturable fungal bioaerosols within the spaces controlled by the AHUs with 95% final filters (all except AHUs 11 and 13) are at least 75% lower than outside air concentrations, indicating that the filters are performing and removing particulates from the air.
The bacterial concentrations (incubated at 25°C) within the space controlled by AHUs 10 and 11 were higher indoors than outdoors. Unlike fungi, bacteria have natural reservoirs indoors (including humans), and total bacterial concentrations are often higher indoors than outdoors. (Macher 1999) The bacterial organisms identified (incubated at 25°C) as indicators of an indoor source were Micrococcus species, Micrococcus luteus, Staphylococcus capitus, and Staphylococcus hyicus, which are human-shed bacteria. (Wilson 2005) Because these organisms are human-shed and were not identified as indoor contaminants via surface sampling, it cannot be concluded that these higher concentrations of bacteria detected via air sampling were the result of building-related sources of bacterial contamination. (Macher 1999) Higher indoor concentrations of human-shed bacteria are an anticipated condition within a building. The bacteria Bordetella bronchiseptica was identified inside AHUs 10, 11, 13, 16, 18, 19 and was not identified indoors via air sampling. Viridans streptococci was identified inside AHU 18 and not identified in indoor air samples. Staphylococcus aureus was identified inside AHU 21 and not identified in indoor air samples. This is a strong indication that the filters may prevent the transmission of Bordetella bronchiseptica, Viridans streptococci, and Staphylococcus aureus through the filters and into the occupied space of the hospital.
With the exception of the bacterial (incubated at 25°C) air samples in AHUs 10 and 11, the percent differences for bacterial sample sets comparing OSA to ISA were at least 35%. This is an indication that the filters were removing bacteria from both the outside and re-circulated air of the Hospital.
3.2. Total outside vs. total indoor concentrations (2006 data)
The 2006 sampling data indicate that, in general, the total air concentrations are lower indoors than outdoors. However, indicators of indoor contamination were identified. The 2006 sampling strategy was to compare outdoor fungal and bacterial airborne concentrations with the concentrations identified 1) within each AHU before the filter, 2) within each AHU after the filter, and 3) within a room controlled by the AHU. AHUs 17, 19, and 21 were tested in early 2006.
3.2.1. AHU 17
AHU 17 serves the first floor emergency room and radiology, which are critical areas. Figure 2 summarizes the 2006 data for AHU 17.
The AHU 17 data indicate fungal and bacterial percent differences from OSA to ISA greater than 74%, with the exception of total fungi (spore traps), which is shown as a difference of 1%. Percent differences between before filter and after filter concentrations also show minimum percent differences of 58%, which indicate bioaerosol removal from the air stream after it passes through the filter. The low percent differences for spore traps and culturable air sampling (25°C and 37°C samples) between OSA and ISA (room) indicate indoor contamination as shown by the negative percent difference shown for the after filter to room samples. This is not an indication that the filters are inadequately filtering particles, but rather an indication of an indoor source and/or infiltration due to negative pressure contributing to the indoor concentrations of bioaerosols.
Percent differences show an increase in airborne fungal and bacterial concentrations between the locations after the filter and within the room, indicating an increase in airborne concentrations in the air for both culturable bacteria and fungi and total fungi after it leaves the AHU. Negative percent differences are identified for spore trap samples from before the filter to room and after the filter to room. The increase in concentrations as the air moves from the AHU to the room indicates the presence of an indoor source of fungi and bacteria, specifically yeasts, fungal species of Cladosporium,\n\t\t\t\t\t\tPenicillium, Aspergillus, and Fusarium, and bacterial species of Staphylococcus, Micrococcus, and Sphingomonas paucimobilis.
Figure 2.
AHU 17 percent differences in mean total concentrations between spaces (2006 data).Note: A negative percent difference indicates that the indoor concentration was higher than outdoors for OSA to ISA comparisons.Note: A black top of a bar in the graph in the 0% plane indicates a negative percent difference indicating an increase in concentration from one space to another when a decrease is expected.
3.2.2. AHU 19
AHU 19 serves the 1st Floor Administration Area, Labor and Delivery, Recovery, the Cesarean Section room, Pre-Op Area, the Intensive Care Unit, and a Rehabilitation area. All areas supplied by AHU 19 are considered critical care areas except the Administration Area. The AHU 19 data indicate percent differences that approach or are greater than 90% for fungi and bacteria between OSA and ISA. This indicates that greater than 90% of the bioaerosols in the OSA are being removed from the air stream. The AHU 19 data indicate positive percent differences signifying decreasing concentrations from before the filter to after the filter, before the filter to room, and after the filter to room. Figure 3 summarizes the 2006 data for AHU 19.
3.2.3. AHU 21
AHU 21 serves Radiology, Purchasing, Shipping and Receiving, and Plant Operations. Radiology is a critical area. The AHU 21 data indicate positive percent differences for airborne concentrations comparisons of OSA to ISA. The minimum percent difference is 54% (spore traps) for OSA to ISA comparisons and show more than 50% of the mean total concentrations of fungi and bacteria were being removed from OSA. Percent differences for bacteria incubated at 25°C were negative for the before filter to after filter, before filter to
Figure 3.
AHU 19 percent differences in mean total concentrations between spaces (2006 data).Note: A negative percent difference indicates that the indoor concentration was higher than outdoors for OSA to ISA comparisons.Note: A black top of a bar in the graph in the 0% plane indicates a negative percent difference indicating an increase in concentration from one space to another when a decrease was expected. Note: The 2006 AHU 19 laboratory results were not received from the analytical laboratory for spore trap and fungal samples incubated at 25°C.
room, and after filter to room sample sets, indicating an indoor source of bacteria. Percent differences for bacteria incubated at 37°C were negative for the before filter to room and after filter to room sample sets, indicating an indoor source of bacteria. Percent differences were negative for all sampling sets comparing after filter to room, indicating indoor sources of bacteria and fungi. Percent differences show an increase in airborne fungal and bacterial concentrations between air concentrations after the filter and air concentrations within the room, indicating an increase in airborne concentrations in the air for both culturable bacteria and fungi and total fungi after the air leaves the AHU.
The low percent differences for spore traps and culturable air sampling (25°C and 37°C samples) between OSA and ISA (room) indicate indoor contamination as shown by the negative percent difference shown for the after filter to room samples. This indicates an indoor source or infiltration due to negative building pressure as opposed to inadequate particle filtration by the AHU filters. The increase in concentrations as the air moves from the AHU to the room indicates the presence of an indoor source of fungi and bacteria, specifically fungal species of Rhodotorula, Penicillium, Aspergillus, Verticillium, Nigrospora, Paecilomyces, Cladosporium, Engyodontium, Rhizopus, and Scytalidium, and bacterial species of Acinetobacter, Chryseomonas, Pseudomonas, Tatumella, and Staphylococcus.\n\t\t\t\t\t\tTable 4 summarizes the 2006 data for AHU 21.
Figure 4.
AHU 21 percent differences in mean total concentrations between spaces (2006 data).Note: Negative scale was truncated at -300% for simplicity in graphical presentation.Note: A negative percent difference indicates that the indoor concentration was higher than outdoors for OSA to ISA comparisons.Note: A black top of a bar in the graph in the 0% plane indicates a negative percent difference indicating an increase in concentration from one space to another when a decrease was expected.
3.3. Air sampling indicators of indoor iontamination
Indoor vs. outdoor comparisons of fungi and bacteria are used to document the presence or infer the absence of indoor, biologically derived contamination. (Macher 1999) A substantial number of bacteria and fungi are capable of spreading via the airborne route in hospitals. (Eickhoff 1994) The presence of contamination in dust or on surfaces or water is often considered de facto evidence of human exposure to fungal aerosols. (Burge 2000)
When evaluated as total concentrations, the air sampling results generally indicate lower concentrations of fungi and bacteria indoors compared to outdoors. Unless the genera and species have been identified total counts merely indicate gross numbers and indoor vs. outdoor comparisons are not meaningful. (Macher 1999; Weber and Page 2001) An investigator cannot make meaningful indoor vs. outdoor comparisons unless the genera and species found indoors and outdoors have been identified. (Macher 1999) For this project, culturable air samples were analyzed at the species level so that meaningful comparisons could be made.
When evaluated according to genera, air sampling results indicate the potential presence of indoor contamination sources for both bacteria and fungi. Air sampling indicators of an indoor source were identified in the space controlled by each AHU. Indicators of indoor contamination were defined as:
Potential indoor biological source (indoor mean concentration > outdoor mean concentration [tested by the ANOVA, α = 0.05, with differences identified by SNK Post Hoc Grouping] or the organism was identified in the indoor air samples but not identified in the outdoor reference samples (n ≥ 12) for the space controlled by each AHU),
Meets the criteria of 1 above (a potential indoor biological source) and is a confirmed indoor contamination source via surface sampling in the space controlled by each AHU,
Meets the criteria of 1 above (a potential indoor biological source) and the organism was not identified in all outdoor air samples (n ≥ 48), indicating an indoor source of air contamination, and
Meets the criteria of both 2 and 3 above, confirming an indoor source of air contamination.
Air sampling identified indicators of indoor contamination within each space investigated in both the 2005 and 2006 data. While indoor bacterial sources are expected within occupied buildings, the species of fungi found in indoor and outdoor air should be similar. (Weber and Page 2001) Outdoor air samples serve as the primary comparison to indoor bioaerosol samples and the types of fungi present indoors should not be significantly different from the outdoor environment. (Spicer and Gangloff 2000) To determine if the indoor and outdoor bioaerosol profiles were similar, the means of the sampling data were tested for biodiversity. The numbers of air sampling indicators identified per AHU from the 2005 air sampling data are shown in Figure 5.
Figure 5.
Number of Air Sampling Indicators of Indoor Contamination per AHU.
Air sampling indicators identified per AHU from the 2006 air sampling data are shown in Figure 6.
Figure 6.
Number of air sampling indicators identified via air sampling (2006 data).
Figures 7 and 8 illustrate the percentage of air sampling indicators discussed in the Air Sampling Indicators of Indoor Contamination section that were confirmed via surface sampling or not detected in the outside air reference samples, indicating an indoor source of contamination.
Figure 7.
Percentage of air sampling indoor source indicators confirmed via surface sampling or not detected in the OSA.
Figure 8.
Percentage of air sampling indoor source indicators not detected in the OSA.
Indicators of indoor contamination that were not identified in outdoor air samples or were identified in indoor samples were found within the space controlled by each AHU investigated. Indicators of indoor contamination identified on surface sampling are associated with the building while indicators not identified in the outdoor air are likely to be associated with the building, building occupants, or another indoor source.
3.4. Tests for biodiversity
The Spearman’s Rank Correlation (SRC) is a non-parametric statistical test for comparing bioaerosol samples from separate environments. SRC is used to assess the similarity of the genera and species of culturable fungi and bacteria in air or source samples and the types of fungal spores in spore-trap samples. Data from a reference site (OSA) can be compared to data from a test site (ISA). Mean concentrations of multiple samples from each sampling location are preferred for use in the calculations for biodiversity. (Macher 1999) Indoor air sampling locations were identified broadly as the space under the environmental control of each AHU investigated. Several samples were taken from each sampling area (space under the environmental control of the AHU) so that mean concentrations could be analyzed statistically. The SRC test for biodiversity allows inferences to be made based upon whether the bioaerosol profile of one location is statistically similar to the bioaerosol profile of another. For fungi, indoor and outdoor profiles should be statistically similar. (Dillon, Heinsohn et al. 1996; Macher 1999; Spicer and Gangloff 2000) For bacteria, however, it is not unusual to have differences in biodiversity, as many bacteria are human shed. (Macher 1999)
The mix of airborne fungal species indoors should be similar to that found in the outdoor air. (Weber and Page 2001) In assessing indoor air quality with regards to airborne fungi, the types of fungi present in the indoor environment should not be significantly different from the outdoor environment. Similarity indicates that the building is not promoting or amplifying the growth of microorganisms. (Spicer and Gangloff 2000) A zero value was used as a replacement for microorganisms that were not detected in a sample. (Spicer and Gangloff 2000)
The biodiversity can be measured either as a combined aerobiological profile of fungi and bacteria, or separately. Here, bacteria and fungi are considered separately. (Macher 1999) Indoor source aerosols tend to be dominated by the readily released spores of Aspergillus and Penicillium species. (Burge 2000) The culturable air sampling results of Aspergillus and Penicillium species (at both 25°C and 37°C ) were tested to determine if indoor vs. outdoor species identified were similar. Table 2 summarizes the SRC test results for biodiversity. Tests for biodiversity were conducted with SPSS 14 Statistical Software. The level of significance was prescribed as α = 0.05. A significant correlation (p-value ≤ α ≤ 0.5) indicates that there is statistical evidence that the biodiversity of the indoor air is similar to the biodiversity of the OSA. Similarity indicates that the building is not promoting or amplifying the growth of microorganisms, while dissimilarity indicates that the biodiversity of indoor and OSA are independent and that the indoor environment is amplifying the growth of microorganisms. (Dillon, Heinsohn et al. 1996; Macher 1999; Spicer and Gangloff 2000) Similarities in the biodiversity of indoor and outdoor air are unlikely to have occurred by chance, and at the α = 0.05 (5%) level of significance, the result could have occurred by chance one time in 20. Statistical techniques evaluate an observed difference in view of its precision to determine with what probability it might have arisen by chance (the level of significance). Values with a low probability of occurring by chance are called statistically significant and are considered to represent a real effect (e.g. difference or similarity in biodiversity). (Dillon, Heinsohn et al. 1996; Conover 1999; Macher 1999) The SRC applied to bioaerosol samples in the tests for differences between OSA and ISA biodiversity at the species level for culturable bacteria and fungi and at the genus level for spore traps.
The 2005 data show consistent dissimilarity between the bioaerosol profiles of ISA and OSA for species of Penicillium and Aspergillus at both 25°C and 37°C (86% dissimilar). For AHUs 16, 17, 18, and 19, bacterial and fungal biodiversities are similar to OSA. Yet, the biodiversity of Penicillium species and Aspergillus species analyzed independently are consistently dissimilar (86% dissimilar) indicating indoor amplification. Spore traps consistently showed 100% similarity because only non-culturable fungi were analyzed at the genus level, masking differences in species present in OSA and ISA. This is an expected occurrence with spore trap analysis because spore traps analysis is not sufficient for identification at the species level. For the 2005 data, the biodiversity of bacteria between OSA and ISA were consistently similar (75% similar). The tests for biodiversity indicate that the diversity of bacterial taxa identified indoors were consistently dissimilar to the bacterial taxa identified outdoors in the space controlled by AHUs 10, 11, 13, and 15.
The 2006 data indicate that the biodiversity between OSA and ISA was dissimilar for the space under the environmental control of AHUs 17, 19, and 21. For the 2006 data, the biodiversity of bacterial tests were consistently dissimilar (83% dissimilar). This may be due to differences in seasons that the tests were conducted. The 2005 samples were taken in summer and the 2006 samples were taken in winter. During winter, OSA bioaerosol concentrations may be lower due to less than ideal growth conditions. Conversely, indoor bioaerosol concentrations of bacteria may be similar year-round due to the presence of human shed sources of bacteria.
4. Sampling interpretation summary
Allergic reactions to indoor allergens [including fungi and bacteria] can produce inflammatory conditions of the eyes, nose, throat, and bronchi. A substantial number of bacteria and fungi are capable of spreading via the airborne route in hospitals. (Eickhoff 1994) Contaminated ventilation or air conditioning systems have been implicated in nosocomial outbreaks, via infective aerosols, dust, and colonized filters. (Eickhoff 1994) Biofilms or slime on HVAC system pan or coil surfaces is an indicator of microbiological amplification. (Pope, Patterson et al. 1993) The growth of microorganisms downstream from the cooling coils can be promoted by water droplets being blown off coil surfaces and into the air. (Pope, Patterson et al. 1993; CDC 2003) Poorly designed HVAC systems may provide for amplification of fungi and Actinomycetes in wet niches of the system. (Pope, Patterson et al. 1993; CDC 2003) In a hospital with high efficiency filters, airborne fungal spores reflect incomplete filtration, infiltration of outside air, and shedding of adherent spores from indoor growth. (Rhame 1991) Nosocomial aspergillosis occurs in direct proportion to the mean ambient hospital airborne spore content. (Rhame 1991) Mini-bursts of spores occur from disturbance of settled spores in dust, shedding spores from clothes or sources such as indoor growth. (Rhame 1991) Immunocompromised persons, children and the elderly are at risk of from exposure to infectious microorganisms. (Boss and Day 2003) In general, the filters show that total quantities of aerobiological contaminants are being removed from the air stream. See the filter discussion in the Total Outside Concentrations vs. Total Indoor Concentrations (2005 Data) section. However, both surface and air samples indicate the presence of indoor microbiological amplification, which is problematic in the indoor environment.
Results for Spearman’s Rank Correlation Testing for Biodiversity
AHU
10
11
13
15
16
17
18
19
21
2005 Data
Bacteria @ 25°C
D
D
S
D
S
S
S
S
Not tested in year 1.
Bacteria @ 37°C
S
S
D
S
S
S
S
S
Fungi @ 25°C
D
S
D
D
S
S
S
S
Fungi @ 37°C
D
S
D
D
S
S
S
S
Spore Traps
S
S
S
S
S
S
S
S
Aspergillus @ 25°C
D
D
D
D
D
D
D
D
Penicillium @ 25°C
D
D
D
D
D
S
D
D
Aspergillus @ 37°C
D
S
D
D
*
D
S
S
Penicillium @ 37°C
*
D
D
D
*
D
D
D
2006 Data
Bacteria @ 25°C
Not tested in year 2.
D
Not tested in year 2.
D
D
Bacteria @ 37°C
D
D
S
Fungi @ 25°C
S
**
S
Fungi @ 37°C
D
*
D
Spore Traps
S
**
S
Aspergillus @ 25°C
*
*
*
Penicillium @ 25°C
S
*
*
Aspergillus @ 37°C
*
*
*
Penicillium @ 37°C
*
*
*
Table 2.
Spearman’s Rank Correlation Test for Biodiversity between outdoor and indoor sampling locations. (Significance level α ≤ 0.05)
4.1. Fungal samples
The mix of airborne fungal species indoors should be similar to that found in the outdoor air. Fungal organisms identified indoors, that are not present in the outdoor air or control locations, suggests the presence of an amplifier (growth site) for that species in the building. (Macher 1999; Weber and Page 2001) Most fungi can become opportunistic pathogens in a severely immunocompromised patient. (Weber and Page 2001) Airborne fungi within the hospital setting are especially dangerous because antifungal therapy is still rather ineffective. (Kalliokoski 2003) Although average air concentrations of total culturable fungi indoors were consistently lower than those found outdoors, many types of fungi identified indoors were not found in outdoor reference samples; especially within the species of Aspergillus and Penicillium. (Weber and Page 2001) The biodiversity of species of Penicillium and Aspergillus between indoor and outdoor air was consistently dissimilar for sampling results within the sampling space controlled by each air handling unit. Species of fungi identified within the hospital in air and on surfaces that are associated with airborne transmission or NI are Penicillium, Aspergillus, Rhizopus, Acremonium, and Fusarium. (CDC 2003)
Indicator organisms identified via air sampling in the hospital are Aspergillus versicolor,\n\t\t\t\t\tA. flavus, A. fumigatus, species of Fusarium and Penicillium, and yeasts. (Macher 1999) Some indicator organisms identified on indoor surfaces within the Hospital are species of Aspergillus, Chaetomium,\n\t\t\t\t\tStachybotrys, Penicillium, Fusarium, Acremonium, Trichoderma, and yeasts. The presence of indicator organism contamination on surfaces indicates long-term or severe moisture problems. (Boss and Day 2003) Indicator organisms were identified on surfaces within the space controlled by each AHU investigated in 2005.
Exposure to fungi actively growing indoors may present unusual health risks even when total fungal concentrations are higher outdoors. (Macher 1999) Exposure to damp indoor environments and the presence of molds in damp indoor environments are associated with asthma symptoms in sensitized asthmatic persons. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Serious respiratory infections resulting from exposure to Aspergillus species and Fusarium species are common in persons who are immunocompromised. It is likely that many of these fungal infections are contracted through contact with fungi in indoor environments, because poor health conditions limit people with severely impaired immune systems to spend most of their time indoors. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) The lungs of persons with chronic pulmonary disorders such as cystic fibrosis, asthma, and chronic obstructive pulmonary disorder may become colonized and potentially infected with Aspergillus species. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Healthy persons exposed to damp or moldy indoor environments report that they are more prone to respiratory infections, including the common cold, sinusitis, tonsillitis, otitis, and bronchitis. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Fungi have become the largest cause of occupational diseases among healthcare workers in Finland. (Kalliokoski 2003)
Indoor source aerosols tend to be dominated by the readily released spores of Aspergillus and Penicillium species (Burge 2000), which produce large numbers of spores that are easily released into the air. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Indoor exposure to Aspergillus and Penicillium species spores has been shown to be associated with an increased risk of allergic sensitization in children (Wilson, Holder et al. 2004) and are chiefly involved in the genesis of asthma and allergic alveolitis (pulmonitis due to hypersensitivity). (Perdelli, Christina et al. 2006) Bronchial asthma is frequently provoked by airborne fungal spores belonging to the genera Aspergillus and Penicillium. (Smith 1990) Species of Aspergillus and Penicillium are considered indicator organisms that may signal unwanted moisture intrusion and/or a potential for health problems. (Macher 1999) As such, the biodiversity of both Penicillium and Aspergillus species was tested to determine whether the outdoor air was the primary source for the fungi identified in the indoor air. (Macher 1999)
Aspergillus and Penicillium species are two of the most ubiquitous fungi known. Large quantities of fungal spores are produced when these fungi are actively growing. During germination, large quantities of spores are produced, and when sporulation occurs, several thousand spores may be disseminated per cubic meter of air. (Wenzel 1997) Penicillium and Aspergillus spores are sphere-like, measuring from approximately 2-5 micrometers in diameter and can be suspended very easily in the air. (Wenzel 1997; Straus 2004) Spores of Penicillium species often cannot be distinguished via microscopic examination from spores of Aspergillus species and vice versa. (Stetzenbach and Yates 2003) Once suspended, they may remain suspended for prolonged periods, and when those spores settle, they can contaminate any surface in contact with air. (Wenzel 1997) Once inhaled, these spores travel through the airways into the lower regions of the lungs, leading to the potential development of respiratory symptoms. (Straus 2004)
4.1.1. Aspergillus species
The presence of Aspergillus species in health-care environments is a substantial extrinsic risk factor for opportunistic invasive aspergillosis (invasive aspergillosis being the most serious form of the aspergillosis). (CDC 2003) The presence of Aspergillus contamination and/or growth within a health care facility is of particular concern due to the presence of immunocompromised persons. Causative agents of aspergillosis are Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus terreus, and Aspergillus nidulans. (CDC 2003) Airborne concentrations of Aspergillus species at or below 0.1 cfu/m3 have been recommended for the prevention of nosocomial aspergillosis. (Weber and Page 2001) Low concentrations of A. fumigatus and A. flavus have been associated with nosocomial aspergillosis in immunocompromised patients. (Arnow, Sadigh et al. 1991) Among immunosuppressed patients in general, invasive aspergillosis remains a serious complication and may be lethal. (Perdelli, Christina et al. 2006)
The genus Aspergillus is one of the most ubiquitous fungi known. Large quantities of fungal spores are produced when actively growing. The Aspergillus spores are inhaled easily because of their small aerodynamic size and can easily reach and colonize the upper respiratory tract, including paranasal sinuses and terminal airways. (Wenzel 1997) Nosocomial pulmonary and disseminated aspergillosis arises from inhalation of fungal spores. (Rhame, Streifel et al. 1984) The use of powerful new chemotherapy protocols for malignancies and certain immunologic disorders and the increasing use of organ transplantation are risk factors for nosocomial aspergillosis. Patients with acute or chronic myelogenous leukemia and AIDS are particularly susceptible to nosocomial aspergillosis. In the transplant population and in patients with aplastic anemia, Aspergillus has emerged as a major cause of death. (Wenzel 1997)
Nosocomial aspergillosis is primarily established when an immunocompromised host inhales fungal spores present in the air. (Rhame, Streifel et al. 1984; Wenzel 1997) Any dust-generating activity, such as maintenance of ventilation systems, cleaning, vacuuming, and dry mopping, can render Aspergillus spores airborne and potentially cause outbreaks of nosocomial aspergillosis. The achievement of a spore-free air within an area or ward of a hospital may not be sufficient to eradicate nosocomial aspergillosis because of “non-ward” sources of Aspergillus within the hospital, such as radiology, radiation therapy units, and other areas visited by patients where engineering and environmental controls may not be as stringent. (Wenzel 1997) Fungi actively growing indoors compounds the problem associated with the prevention of nosocomial aspergillosis.
Species of Aspergillus found indoors should be similar to species identified outdoors. With the exception of AHU 11, all AHUs have filters of 90% efficiency or greater. 90% and 95% filters are considered high efficiency (Boss and Day 2003) and rated to remove 90% of particles from 1-10 micrometers and almost all particles greater than 10 micrometers in size. (ASHRAE 1992; ASHRAE 1999) Due to the presence of high efficiency filters in the AHUs investigated (except AHU 11), indoor concentrations should be statistically lower than outdoor concentrations and organisms not detected outdoors should not be detected indoors (Weber and Page 2001) (with the exception of indoor-source bacteria (Macher 1999)). However, many species of Aspergillus were detected indoors and not outdoors or indoor concentrations were greater than or not statistically different than outdoor concentrations, indicating an indoor source or infiltration.
The average concentration of A. fumigatus for culturable fungal air samples at 25°C was 0.50 cfu/m3 (n=14 indoors, n=38 outdoors) in the space controlled by AHU 15. The biodiversity of species of Aspergillus between indoor and outdoor air was consistently dissimilar for sampling results (incubated at 25°C) within the sampling space controlled by each air handling unit, indicating the presence of indoor fungal amplifiers; the building appears to be promoting or amplifying the growth of species of Aspergillus. (Macher 1999; Spicer and Gangloff 2000; Weber and Page 2001)
Of particular concern in a hospital setting are the presence of thermotolerant fungi, including A. fumigatus and A. flavus. Thermotolerant fungi are of primary concern in healthcare facilities, since they can cause infection in at-risk patients, even when concentrations are very low. (Page and Trout 2001) Concentrations of thermotolerant A. fumigatus (incubated at 37°C) were 1.17 (n=12 outdoors, n=6 indoors) and 3.50 cfu/m3 (n=12 indoors, n=22 outdoors) in the spaces controlled by AHUs 13 and 15, respectively. Indoor concentrations of A. flavus were not statistically different than outdoor concentrations in the spaces controlled by AHUs 11 and 17 for samples incubated at 25°C and AHUs 11, 17, and 18, for samples incubated at 37°C. This is an expected condition within the space controlled by AHU 11 due to the absence of final filters. This suggests the presence of an indoor source of A. flavus or outdoor air infiltration within the spaces controlled by AHUs 17 and 18. Indoor A. flavus concentrations detected in the space controlled by AHUs 10 and 19 were lower than OSA concentrations (statistically significant difference at the α = 0.05 level of significance). The biodiversity of species of thermotolerant Aspergillus between indoor and outdoor air was consistently dissimilar for sampling results within the sampling space controlled by AHUs 10, 13, 15, and 17, indicating the presence of indoor fungal amplifiers; the building appears to be promoting or amplifying the growth of species of Aspergillus. (Macher 1999; Spicer and Gangloff 2000; Weber and Page 2001)
Indoor concentrations for culturable Aspergillus species incubated at 25°C (A. flavus, A. sydowii, A. nidulans, A. niger, A. fumigatus, A. flavipes, A. sclerotiorum, A. terreus, A. versicolor) that exceeded indoor concentrations, were not statistically different to outdoor concentrations, or not detected in the outdoor reference samples were identified in the space controlled by AHUs 11, 13, 15, 16, 17, 18, and 19. Indoor concentrations of thermotolerant species of Aspergillus (A. flavus, A. sydowii, A. niger, A. fumigatus, A. terreus) that exceeded indoor concentrations, were not statistically different to outdoor concentrations, or not detected in the outdoor reference samples were identified in the space controlled by AHUs 10, 11, 13, 15, 17, and 18.
Potentially hazardous concentrations of A. fumigatus were identified in the spaces controlled by AHUs 13 and 15. (Weber and Page 2001) Moisture intrusion via infiltration, leaks, inadequate HVAC control, etc. has provided a chronically moist indoor environment ideal for fungal growth. Air infiltration due to negative building pressurization allows the introduction of unfiltered air into the hospital. Air samples indicated the presence of indoor fungal reservoirs/amplifiers within the spaces controlled by all AHUs investigated. Air and surface sampling indicated microbial growth, dissemination and, hence, occupant exposure, from the indoor microbial reservoirs. (Weber and Page 2001) An indoor environment has been created in which immunosuppressed or allergic patients within the Hospital are not fully protected against the risk of infection and the allergenic effects of Aspergillus species (Perdelli, Christina et al. 2006) and otherwise healthy persons may suffer exacerbation of allergies and be prone to increased incidences of respiratory infections, including the common cold, sinusitis, tonsillitis, otitis, and bronchitis. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004)
General controls for prevention of nosocomial aspergillosis are: air filtration, positive pressurization, avoidance of dust-generating activities, attention to non-filtered air infiltration, protection of immunocompromised patients who enter areas without highly filtered air, and isolation of hospital construction. (Wenzel 1997) Highly filtered air is essential to preventing person-to-person and environmentally related infections. (Boss and Day 2003) However, it is important to note that the use of highly filtered air conditioning systems does not provide complete protection against fungi actively growing or infiltrating into a facility. (Perdelli, Christina et al. 2006) Nosocomial aspergillosis has been associated with poorly maintained and/or malfunctioning HVAC systems. (CDC 2003)
4.1.2. Penicillium species
As with Aspergillus species, the genus Penicillium is one of the most ubiquitous fungi known and one of the most commonly isolated molds from contaminated buildings. With Penicillium species the main cause for concern is allergic disease, as infections due to Penicillium species are rare. Indoor concentrations of Penicillium species greater than outdoor concentrations are associated with negative health effects in humans. Penicillium species has been correlated with allergic asthma, allergic alveolitis, atopy, increased lower respiratory infections in children during the first year of life, and wheezing. (Straus 2004)
Inhalation of Penicillium species spores has been shown to provoke immediate and delayed-type asthma in individuals already sensitized to Penicillium. (Straus 2004) Infants with high risk for the development of asthma (e.g. due to premature birth and/or ethnicity) may be at significant risk for persistent cough and wheeze when exposed to Penicillium species spores. Penicillium species have been shown to cause allergic alveolitis due to exposure from a faulty installation of a HVAC system. (Straus 2004) Penicillium is a large group of fungi valued as producers of antibiotics. Penicillium may cause allergic reactions, exacerbate asthma, and cause other adverse health effects when dispersed through air. (Boss and Day 2003; Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) The blue-green molds of Penicillium are common contaminants of indoor environments. Inhalation of spores is the major route of entry. Penicillium species have been associated with asthma and hypersensitivity pneumonitis (Weber and Page 2001) and can cause NI in the immunocompromised host. (Fox, Chamberlin et al. 1990; Walsh and Groll 1999; CDC 2003) Penicillium species spores have been shown to be associated with an increased risk of allergic sensitization in children (Straus 2004) and are chiefly involved in the genesis of asthma and allergic alveolitis (pulmonitis due to hypersensitivity). (Perdelli, Christina et al. 2006) One 2.5 cm diameter colony of Penicillium species can produce 400,000,000 spores that can become airborne and generate increased concentrations of airborne spores. (Hitchcock, Mair et al. 2006)
The biodiversity of Penicillium species between ISA and OSA was consistently dissimilar for sampling results (incubated at 25°C ) within the sampling space controlled by each AHU (except AHU 17), indicating the presence of indoor fungal amplifiers; the building appears to be promoting the growth of species of Penicillium. (Spicer and Gangloff 2000) Thermotolerant fungi are of primary concern in healthcare facilities, since they can cause infection in at-risk patients, even when concentrations are very low. (Weber and Page 2001) The biodiversity of species of thermotolerant Penicillium between indoor and outdoor air was consistently dissimilar for sampling results within the sampling space controlled by each AHU (except AHUs 10 and 16 because tests could not be performed), indicating the presence of indoor fungal amplifiers; the building appears to be promoting or amplifying the growth of species of Penicillium. (Macher 1999; Spicer and Gangloff 2000; Weber and Page 2001)
Species of Penicillium found indoors should be similar to species identified outdoors. With the exception of AHU 11, all AHUs have filters of 90% efficiency or greater and should remove greater than 90% of particles between 1 and 10 micrometers in size. Due to the presence of high efficiency filters in the AHUs investigated (except AHU 11), indoor concentrations should be statistically lower than outdoor concentrations and organisms not detected outdoors should not be detected indoors (with the exception of indoor-source bacteria). (Weber and Page 2001) However, many species of Penicillium were detected indoors and not outdoors or indoor concentrations were greater than or not statistically different than outdoor concentrations. Indicators of indoor contamination of Penicillium species were identified in the space controlled by each AHU.
Indoor airborne concentrations of culturable Penicillium species incubated at 25°C (P. citrinum, P. chrysogenum, P. corylophilum, P. decumbens, P. duclauxii, P. funiculosum, P. glabrum, P. implicatum, P. janthinellum, P. oxalicum, P. pinophilum, P. purporogenum, P. sclerotiorum, P. variabile, P. waksmani) that exceeded or were similar to outdoor concentrations or not detected in the outdoor reference samples were identified in the space controlled by each AHU. Indoor airborne concentrations of thermotolerant (incubated at 37°C) species of Penicillium (P. citrinum, P. chrysogenum, P. decumbens, P. funiculosum, P. janthinellum, P. oxalicum, P. pinophilum, P. simplicissimum) that exceeded or were similar to outdoor concentrations or not detected in the outdoor reference samples were identified in the space controlled by each AHU, with the exception of AHU 10 where no thermotolerant species of Penicillium were identified.
4.1.3. Yeasts
Yeasts are found in a variety of natural habitats or organic substrates such as plant leaves, flowers, soil, and salt water. Some yeasts are part of the normal human flora. Although yeasts may be part of the normal human flora, they were detected on indoor surfaces. Therefore, it can be concluded that the yeasts identified as indicators of indoor contamination were most likely from an indoor contamination source. (Macher 1999) The presence of yeasts actively growing indoors is of concern, as yeasts are considered an indicator organism and can cause infections in the immunocompromised host. Some yeasts are reported to be allergenic, and may cause problems in individuals with previous exposure and developed hypersensitivities. Yeast infections are among the most common fungal infections in humans. Their form ranges from localized cutaneous or mucocutaneous lesions, to fungemia or disseminated systemic mycoses. (AerotechP&K 2006) Indoor concentrations of yeasts exceeded outdoor concentrations or were detected indoors and not outdoors in the spaces controlled by AHUs 10, 13, 15, and 19. See indicators of indoor contamination for both 2005 and 2006 data. Yeasts were identified via surface sampling within the spaces controlled by AHUs 10, 11, 13, 15, 16, 17, 18, and 19.
4.2. Bacterial samples
Like fungi, bacteria actively growing indoors can release spores into the air (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004). Additionally, bacteria secrete enzymes that can act as allergens. Enzymes and spores from Gram-positive bacilli and thermophilic Actinomycetes have been implicated in epidemics of hypersensitivity pneumonitis and work-related asthma. Concentrations of bacteria associated with sensitization or provoking human allergic reactions are unknown. (Pope, Patterson et al. 1993) Bacteria are known to cause diseases either as pathogens or as opportunistic pathogens in the immunocompromised host. (Boss and Day 2003) Environmental bacteria also grow in all wet spaces and are found in most cases where there is fungal growth. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Some bacteria that are common in outdoor air may penetrate to building interiors and may also grow indoors. (Macher 1999) Unlike fungi, bacteria have natural reservoirs indoors (primarily humans), and total bacterial concentrations are often higher indoors than outdoors. (Macher 1999)
The bacterial organisms identified (incubated at 25°C) as indicators of an indoor source were Acinetobacter lwoffi, Gram (+) cocci, Micrococcus luteus, Micrococcus species, Staphylococcus species (S. auricularis, S. capitus, S. epidermis, S. hominis, S. hyicus, S. warneri, and S. xylosus) which are human-shed bacteria. (Wilson 2005) Because these organisms are human-shed and were not identified as indoor contaminants via surface sampling, it cannot be concluded that these higher concentrations of indoor-source bacteria detected via air sampling were the result of building-related sources of bacterial contamination. (Macher 1999)
The bacterial organisms identified (incubated at 37°C) as indicators of an indoor source were Gram (-) cocci, Pseudomonas aeruginosa, Pseudomonas stutzeri, Rhizobium radiobacter, and Tatumella ptyseos. Gram (-) bacteria are usually not present on the skin (with the exception of Acinetobacter species). Pseudomonas aeruginosa can be found on skin, but is also considered an environmental organism and may be associated with building contamination and/or infiltration. (Wilson 2005) Pseudomonas stutzeri and Rhizobium radiobacter are considered environmental source organisms. The presence of airborne concentrations of Pseudomonas stutzeri (identified via surface sampling on a ceiling tile in the space controlled by AHU 19), and Rhizobium radiobacter indicates the presence of an indoor environmental source (amplification).
Acinetobacter species may cause NI and death in infants during periods of airborne dissemination. Environmental conditions leading to an increase in air conditioner condensate in HVAC systems may increase the risk of nosocomial infection with Acinetobacter species. (McDonald, Walker et al. 1998) Acinetobacter species have been cultured from air conditioners in a hospital nursery. (CDC 2003) Acinetobacter\n\t\t\t\t\tlwoffi species was identified as an indicator of an indoor source via air sampling in the space controlled by AHUs 13 and 21. Acinetobacter species are widely distributed in the environment and are frequently found on human skin. (Wilson 2005) Acinetobacter sp. are a main causative agent of pneumonia, which is a leading cause of morbidity and mortality and is the sixth most common cause of death in the United Kingdom and the Untied States. (Wilson 2005) The presence of Acinetobacter sp. in the air is of concern in the hospital environment. There is no indication that the indoor source of Acinetobacter species was associated with building contamination, but is likely associated with infiltration.
Pseudomonas species are common in the outdoor air, but rarely occur in indoor air. (Macher 1999) P. aeruginosa was identified as an indicator of indoor contamination in the space controlled by AHU 11. This may be due to the absence of final filters in AHU 11. Airborne infections by P. aeruginosa have been reported. (Kalliokoski 2003) Transmission of P. aeruginosa may occur through direct patient-to-patient contact, environmental contamination, or via the hands of health care workers. (Kerr, Moore et al. 1995; Beggs and Kerr 2000) Airborne P. aeruginosa was detected within the hospital in 2005 during a pilot study of proposed sampling equipment in the basement of the Hospital. These sampling results must be viewed as a qualitative indication of an indoor source of P. aeruginosa, as the equipment utilized in the 2005 pilot study was determined to be inaccurate for the determination of airborne concentrations but sufficient for qualitative identification of the bacterium at high concentrations within the space tested. P. aeruginosa is an environmental organism typically found on skin of people and has been isolated environmentally from soil, manure, canal water, and straw. P. aeruginosa is a ubiquitous soil organism that proliferates in standing water and wet and warm materials such as leaking hot water pipe insulation and showers. (Boss and Day 2003; CDC 2003; Stetzenbach and Yates 2003) P. aeruginosa is an opportunistic pathogen and can be especially problematic for those with cystic fibrosis and burn victims. (Boss and Day 2003; CDC 2003; Gaynes and Edwards 2005) Nosocomial infections due to P. aeruginosa have been associated with poorly maintained and/or malfunctioning HVAC systems. (CDC 2003) P. aeruginosa causes urinary tract and skin infections, septicemia (blood infections), and meningitis. (Boss and Day 2003; Wilson 2005) P. aeruginosa is a main causative agent of pneumonia, which is a leading cause of morbidity and mortality and is the sixth most common cause of death in the United Kingdom and the Untied States. (Wilson 2005) The presence of P. aeruginosa in the air is of concern in the hospital environment.
Pseudomonas stutzeri was identified as an indicator of an indoor source in the space controlled by AHU 15 (2005 data) and AHU 19 (2006 Data). It is considered an environmental organism and has been isolated from soil, manure, canal water, and straw. It has been isolated from the respiratory tract, wounds, blood, urogenital tract, spinal and joint fluid of humans and is associated with NI. (Palleroni, Doudoroff et al. 1970; Reisler and Blumberg 1999; Taneja, Meharwal et al. 2004; Lalucat, Bennasar et al. 2006; Yee-Guardino, Danziger-Isakov et al. 2006) P. stutzeri surface contamination was confirmed from a ceiling tile within the space controlled by AHU 19. The presence of indoor contamination of P. stutzeri is of concern in the hospital environment.
Pseudomonas species are one of the most antibiotic resistant bacteria and resistant to antiseptics such as quaternary ammonium compounds. (Georgiev 1998; Boss and Day 2003) This property allows them to survive environmental conditions which are lethal to many other bacteria. (Georgiev 1998) Pseudomonas species in general are among the most clinically relevant healthcare associated pathogens. (CDC 2003) In general, the presence of Pseudomonas in a hospital setting is problematic. (Boss and Day 2003) P. fluorscens was identified as a contaminant in the drain pan water of AHU 19 and P. Stutzeri was identified as surface contamination in the space controlled by AHU 19. The presence of Pseudomonas species actively growing in the indoor healthcare environment is especially problematic. (Boss and Day 2003)
Rhizobium species are environmental source fungi typically found in the roots of plants and in soils. (Stetzenbach, Buttner et al. 2004) Rhizobium radiobacter was identified as an indicator of indoor contamination in the space controlled by AHU 11, and was not detected in the outdoor air (n = 118 outdoor air samples). This indicates the presence of an indoor source. Rhizobium sp. is recognized as an opportunistic human pathogen associated with NI in the immunocompromised host. (Lai, Teng et al. 2004) It is likely that the absence of final filters in the space controlled by AHU 11 prevented indoor concentrations of Rhizobium sp. from being removed from the air stream. It is likely that the R. radiobacter contamination originated from within the Hospital from an environmental source.
Staphylococcus aureus was identified in the condensate water of AHU 21 (2006 data). The presence of S. aureus actively growing indoors should be considered a health risk in the hospital environment. S. aureus produces toxins and can infect surgical wounds, develop resistance to antibiotics, and is the agent of toxic shock syndrome. S. aureus also produces toxins that cause food poisoning. (Boss and Day 2003) S. aureus was not identified in the indoor air via air sampling.
Tatumella sp. is a member of the family Enterobacteriaceae, which are widely distributed in soil, water, plants, and animals. (Hollis, Hickman et al. 1981; Georgiev 1998) Enterobacteriaceae are responsible for over half of the NI in the United States. (Hollis, Hickman et al. 1981) Tatumella ptyseos was identified as an indicator of an indoor source in the space controlled by AHUs 10 (2005 data) and 21 (2006 data). T. ptyseos is associated with NI, but there is no indication that the indoor source of Tatumella species was associated with building contamination.
4.2.1. Actinomycetes
Actinomycetes were once considered fungi because of their resemblance to fungi. However, these organisms are not fungi, but are bacteria. (Georgiev 1998; AerotechP&K 2006) The presence of Actinomycetes is rare in buildings and outdoors. The presence of Actinomycetes indoors may be considered an indication of an indoor environmental source (Macher 1999) and may add to the complexity of the environmental problem. (Straus 2004) The Actinomycetes have the potential to become opportunistic, especially in immunocompromised hosts. (McNeil and Brown 1994; Georgiev 1998)
Thermophilic Actinomycetes are usually found in closed barns, silos, grain mills, and bagasse (sugar cane waste). Actinomycetes have been found in problematic or poorly maintained air conditioning ducts. (AerotechP&K 2006) Allergic respiratory disease caused by the Actinomycetes is referred to as farmer’s lung, a hypersensitivity reaction from repeated exposure to antigens produced by the Actinomycetes. Actinomycetes may also cause other diseases such as ocular infections, periodontal disease, and abscess formations, which can infect humans. (Georgiev 1998) Several reports indicate that infections by these bacteria are not rare (especially from the Actinomycete genus Nocardia), are frequently misdiagnosed, or are under diagnosed, and that the incidence of infection is increasing. The spectrum of disease caused by Nocardia is broad and varies from a self-limited, asymptomatic infection to an aggressive, destructive disease resulting in death. Nocardial infections are commonly diagnosed in previously healthy adults with no predisposing factors. (McNeil and Brown 1994) The Nocardiae are frequently being recognized as emerging opportunistic pathogens; the most common underlying predispositions include organ transplantation, malignancies, use of corticosteroids, alcohol abuse, diabetes, or other debilitating factors. (McNeil and Brown 1994; AerotechP&K 2006)
Nocardioform bacilli and/or presumptive Nocardioforms were identified as indicators of an indoor microbiological source in the space controlled by AHUs 17, 18, and 19. Nocardioforms include the genus Nocardia and the Nocardioform\n\t\t\t\t\t\tActinomycetes. (Georgiev 1998; Boss and Day 2003; Gibson, Gilleron et al. 2003; Stetzenbach and Yates 2003) Nocardia species are the Nocardioform most often isolated from NI. (Georgiev 1998) Nocardia are found in soil around the world, and the indoor concentrations of Nocardioforms were not identified via surface sampling and could not be associated with building contamination. (Macher 1999) Nocardia morphologically resembles Actinomyces species, and both are bacteria that are often pathogenic and opportunistic. (McNeil and Brown 1994; Georgiev 1998; Boss and Day 2003; AerotechP&K 2006)
Actinomycetes were detected indoors via air sampling and not outdoors (n=94 outdoor air samples) within the space controlled by AHU 10 and AHU 17 for the fungal samples incubated at 25°C. Actinomycetes were detected indoors and not outdoors (n=48 outdoor air samples) via air sampling within the space controlled by AHU 19 for the fungal samples incubated at 37°C. Actinomycetes were confirmed via surface sampling within the spaces controlled by AHUs 13, 15 (Actinomyces sp.), 16, and 17 (Actinomycetes-like). Therefore, it can be concluded that the airborne concentrations of Actinomycetes identified within the Hospital were due to an indoor source of surface contamination. (Macher 1999) The presence of Actinomycetes indoors is of concern in the indoor hospital environment.
5. Surface sampling interpretation and health risk model
Allergic reactions to indoor allergens can produce inflammatory diseases of the eyes, nose, throat, and bronchi, which are medical problems that come under the headings of allergic conjunctivitis, allergic rhinitis, allergic asthma, and hypersensitivity pneumonitis (extrinsic allergic alveolitis) respectively. (Pope, Patterson et al. 1993) The Health Risk Model (HRM) considers the type of microbial contamination and the type of person expected to be within a specific Hospital location. Critical care areas are areas of the Hospital where it is expected that immunocompromised persons will be present and therefore contamination within a critical care area is given a higher weight in the overall determination of health risk.
Risk assessment is a process designed to evaluate the potential relationship that may exist between exposure to aeroallergens and a particular effect (e.g. toxic effect, allergic sensitization, infection, allergic disease). (Pope, Patterson et al. 1993) A HRM was utilized to semi-quantitatively identify the health risk associated with fungal and bacterial surface contamination within the hospital. Monitoring for allergens can help characterize environments with respect to specific allergens (e.g., fungi and/or bacteria). Both fungi and bacteria secrete enzymes that act as allergens. (Pope, Patterson et al. 1993) Source or reservoir samples have been used as indicators of exposure to indoor allergens and measurement interpretations can be semi-quantitative (e.g., “presence or absence” or “low, medium, or high). (Pope, Patterson et al. 1993) Environmental bacteria also grow in all wet spaces and are found in most cases where there is mold growth. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004)
The American Industrial Hygiene Association’s consensus document A Strategy for Assessing and Managing Occupational Exposures (Mulhausen and Damiano 1998) served as the basis for the HRM. The HRM utilized criteria and recommendations of the Centers for Disease Control and Prevention (CDC 2003), US Environmental Protection Agency (USEPA 2001), American Conference of Governmental Industrial Hygienists (ACGIH 1999), Institute of Medicine (Pope, Patterson et al. 1993), the New York City Department of Health and Mental Hygiene (NYCDHMH 2006), the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE 2003) and the Vanderbilt University Medical Center (VUMC 2006) in establishing the risk factors for the model. A literature search was conducted to determine if the organisms identified via surface sampling within the Hospital were allergenic, pathogenic or opportunistic, and capable of producing fungal or bacterial toxin. The HRM resulted in a Health Risk classification of the space controlled by each AHU.
Health Risk was classified as High, Medium, Low, and de Minimis. The risk classifications were determined with input from experts in medical microbiology, industrial hygiene, public health, engineering controls, infection control, and medicine. A de Minimis risk score means that no indoor environmental contamination was found. A low risk score means the environmental conditions present do not indicate extensive biological contamination and/or the risk associated with adverse health affects to building occupants is low. A medium risk score indicates that environmental conditions present an increased risk for adverse health effects to building occupants due to environmental contamination and remediation is necessary. A high risk score indicates that conditions exist for adverse health effects due to exposure to biological contaminants and immediate intervention is necessary. Figure 9 below displays the HRM scores for the indoor space controlled by each AHU.
Indoor surface fungal and bacterial surface contamination was identified in every area of the hospital investigated. Air sampling confirmed the presence of indicators of indoor contamination in each of the spaces investigated. See Section 4. Sampling Interpretation Summary above. The spaces under the control of every AHU placed within the medium risk category. The environmental conditions are present such that immunocompromised or allergic patients are not fully protected against the risk of NI due to environmental bioaerosols. (Perdelli, Christina et al. 2006) Healthy hospital workers are not protected
Figure 9.
Health Risk Model Scores for the space controlled by each AHU.
against allergic reactions to indoor bioaerosols growing within the facility and are at an increased risk of respiratory infections, including the common cold, sinusitis, tonsillitis, otitis, and bronchitis. (Institute of Medicine Committee on Damp Indoor Spaces and Health 2004) Hospital workers who are immunocompromised (e.g., diabetics, asthmatics, those undergoing cancer therapy or who have recent invasive surgery) are more susceptible to allergic reactions and the risk of work-related infections. The results of the HRM indicate that patients and staff are being exposed to microorganisms that are actively growing within the hospital which present a risk higher than what is expected in a hospital without water damage, microbial contamination, moisture infiltration, and OSA infiltration.
Periods of maintenance and non-routine operation of HVAC systems within the hospital can result in filter bypass, dissemination of biological contamination, and the infiltration of unfiltered OSA into the hospital, placing the hospital within the High Risk category due the creation of an exposure pathway during these times. Hence, times during and immediately after maintenance and non-routine operation of the HVAC systems present a high risk for health effects due to bioaerosols in the indoor environment. (CDC 2003)
6. Discussion and hypothesis testing
Indoor microbial contaminants and infectious agents are closely related to water and moisture-related conditions. (Bartley 2000) The scenario that has emerged within the hospital is one in which immunosuppressed or allergic patients are not fully protected against the risk of NI or allergies due to environmental bioaerosols. (Perdelli, Christina et al. 2006) Where an indoor environment is exhibiting growth or airborne suspension of bioaerosols, risk may be determined to exist even if levels are less than outdoor baseline and control levels. (Boss and Day 2003) While indoor bioaerosol concentrations were consistently lower than OSA, the biodiversity was consistently different. Air sampling indicators of an indoor source and microbial surface contamination were identified in each of the areas investigated.
The objectives of environmental control in buildings are to prevent or minimize occupant exposures that can be deleterious to human health and to provide for the comfort and well-being of the occupants. (Pope, Patterson et al. 1993) The inability of the hospital’s environmental systems in the areas investigated to manage moisture has resulted in a situation where patients, visitors, and staff are exposed to airborne microorganisms from indoor surfaces and OSA infiltration that normally would not be present within the building. This has resulted in an indoor environment that is not hygienic from the perspective of environmental contamination associated with the building and building systems.
Infection prevention in the hospital environment is one of the goals of healthcare workers and facilities. (Boss and Day 2003) Visitors, volunteers, and staff can both be infected and infectious. Highly filtered air is essential to preventing infection in healthcare facilities. (Boss and Day 2003) With the exception of AHU 11, all areas investigated were under the environmental control of an air conditioning system with >90% efficiency filters. The presence of the high efficiency final filters was largely responsible for the relatively low concentrations of total bioaerosols identified in the hospital ISA. Of particular concern is that a breach in the integrity of the final filters or dissemination of contamination during maintenance activities or non-routine operation could place the areas of the hospital which now fall into the medium risk category into the high risk category by creating an exposure pathway from contamination within the air handlers, OSA, and re-circulated air of the hospital to the occupant. The high efficiency filters within the AHUs are the hospital’s main defense against nosocomial infection associated with indoor environmental contamination.
Although HVAC systems equipped with high efficiency filters can significantly reduce indoor concentrations of bioaerosols (Perdelli, Christina et al. 2006), the areas of the hospital investigated were under negative pressure, allowing the infiltration of unfiltered OSA, and had visible and confirmed microbial contamination on indoor surfaces and within each AHU. The presence of unfiltered air entering the Hospital via infiltration due to negative building pressurization is of concern (CDC 2003) and is significant risk factor for NI. (Streifel, Lauer et al. 1983; Rhame, Streifel et al. 1984; Rhame 1991; Nolard 1994) Biofilms (communities of bacteria in a matrix) and standing water were present in each of the AHUs investigated in 2005 and indicate the presence of excess moisture and poorly draining drain pans. Biofilms are conglomerates of microorganisms and indicate microbiological amplification within the AHUs. Visible surface contamination was identified within all the areas investigated.
Note that a breach in filter media or during times of HVAC system maintenance such as changing filters or starting and stopping the units, will cause an increase in airborne microorganisms or infiltration of unwanted OSA into the ISA of the Hospital. A failure or malfunction of any HVAC system component may subject patients to discomfort and exposure to airborne contaminants. Accumulation of dust and moisture in HVAC systems increases the risk for spread of health-care-associated environmental fungi and bacteria. If moisture is present in the HVAC system, periods of stagnation should be avoided. Bursts of organisms can be released upon system start-up, increasing the risk of airborne infection. If the ventilation system is out of service, rendering indoor air stagnant, sufficient time must be allowed to clean the air and re-establish the appropriate number of air changes once the HVAC system begins to function again. Reactivation of HVAC systems after shutdown can dislodge substantial amounts of dust and create a transient airborne increase of fungal spores. (CDC 2003) Therefore, during and after non-routine operation of the HVAC systems, the hospital is at high risk for nosocomial infection from environmental microorganisms.
The hypotheses testing results are:
Hypothesis A: The 90-95% final filters are controlling particulate matter generated by the AHUs and preventing contamination downstream of the filters. Note: AHU 11 does not have final filters.
Test: OSA versus ISA comparisons of total bioaerosols and spore traps.
Method: Investigator observations, interpretations, and literature review.
Test Result: Accept Hypothesis A—The final filters are controlling the dissemination of particulate matter and preventing the dissemination of particles downstream of the filters during routine operation. Statistical comparisons showed that indoor concentrations of non-culturable (spore traps) fungal bioaerosols were significantly lower than OSA concentrations. At least 79% (2005 data) of the non-culturable fungal bioaerosols are being removed by the final filters of the AHUs investigated, with the exception of AHU 11, which does not have final filters. At least 66% (2005 data) of the culturable fungal bioaerosols are being removed by the final filters of the AHUs investigated, with the exception of AHU 11, which does not have filters. With the exception of the bacterial (25°C) air samples in AHUs 10 and 11, the percent differences from outside air to indoor air were at least 35%. This is an indication that the filters were removing bacteria from both the outside and re-circulated air of the Hospital. The 2006 data showed a minimum percent reduction of 54% of all fungal samples (culturable and non-culturable) for the before filter to after filter comparisons. Therefore, particulate matter of similar aerodynamic diameters to fungi and bacteria are being removed from the air stream by the final filters.
Hypothesis B: The 90-95% final filters are preventing microbial contamination downstream of the filters.
Test: OSA versus ISA comparisons of bioaerosols.
Method: Investigator observations, interpretations, and literature review.
Test Result: Accept Hypothesis B—The final filters are preventing fungal particulate dissemination downstream of the filters by filtering the particles from the airstreams during routine operation. See Test Result for Hypothesis A. Indoor concentrations of non-culturable fungal bioaerosols were consistently lower and spore trap sampling results indicated that indoor concentrations of fungal bioaerosols were significantly lower than indoor concentrations. At least 66% (2005 data) of the culturable fungal bioaerosols are being removed by the final filters of the AHUs investigated, with the exception of AHU 11, which does not have filters. The 2006 data showed a minimum percent reduction of 54% of all fungal samples (culturable and non-culturable) for the before filter to after filter comparisons. The final filters are preventing the dissemination of bacterial contamination downstream of the filters during routine operation. Species of bacteria were identified within the AHUs and not identified post-filter, indicating that the filters were preventing the dissemination of contamination downstream. Indoor bacterial concentrations were consistently lower than outdoor concentrations. With the exception of the bacterial (25°C) air samples in AHUs 10 and 11, the percent differences from outside air to indoor air were at least 35% for the 2005 data. For the 2006 data, the minimum percent difference from OSA to ISA for bacteria was 64%. This is an indication that the filters were removing bacteria from the air streams. Note that indoor concentrations of bacteria are expected to be higher than outdoors but were consistently lower in the Hospital.
Hypothesis C: Staff is being exposed to potentially harmful concentrations of biological contaminants.
Test: OSA versus ISA comparisons of bioaerosols.
Method: Air samples, indoor surface sampling, HRM, Investigator observations, interpretations, and literature review.
Test Result: Accept Hypothesis D—Both the 2005 and 2006 data show indicators of indoor contamination and confirmed microbial surface contamination in each area investigated. Analysis for biodiversity showed that the bioaerosol profiles of ISA and OSA were consistently different. The HRM places all of the areas investigated in the medium risk category, indicating that staff are at risk for adverse health effects due to environmental contamination.
Hypothesis D: Patients are being exposed to harmful quantities of biological contaminants.
Test: OSA versus ISA comparisons of bioaerosols.
Method: Air samples, indoor surface sampling, HRM, Investigator observations, interpretations, and literature review.
Test Result: Accept Hypothesis E—Both the 2005 and 2006 data show indicators of indoor contamination and confirmed microbial surface contamination in each area investigated. Analysis for biodiversity showed that the bioaerosol profiles of ISA and OSA were consistently different, especially for species of Penicillium and Aspergillus. The HRM places all of the areas investigated in the medium risk category, indicating that patients are at risk for adverse health effects due to environmental contamination.
7. Conclusion
This 2-year investigation of bioaerosol concentrations in a hospital facility demonstrates that consideration of error, sampling variability, identification of microorganisms at the species level, and at least 6 replicate samples per location are necessary to detect significant differences in bioaerosol concentrations. Furthermore, spore trap samples were not sufficient to detect these differences regardless of the number of samples taken. Environmental investigators must consider this in their investigation strategy. Of particular importance is the failure of spore trap sampling to detect the same differences in airborne fungal bioaerosol species identified by culturable air sampling. Spore trap sampling should be considered a tool to determine a gross estimation of the quality of the indoor environment with regards to fungal bioaerosols and should not be used to make estimations on health or bioaerosol exposure. In all cases, spore trap sampling failed to detect differences in the aerobiological profile, masking significant concentrations of airborne fungal bioaerosols, including species of Aspergillus and Penicillium.
Statistical validity, analytical/sampling error, and species diversity should be considered for any bioaerol sampling intended to make comparisons on airborne concentrations of bioaersols between two or more environments. Identification of surface contamination should be considered de facto evidence of exposure to potentially harmful biological compounds. This study shows that high efficiency filtration can result in the environmental control of airborne bioaerosols. This is especially important in the hospital setting. PCR sampling shows promise because longer air sampling times can be used, surface samples can detect the presence of organisms on surfaces for an indication of a building’s microbial burden, and because of relatively simple PCR sampling methods.
\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/16329.pdf",chapterXML:"https://mts.intechopen.com/source/xml/16329.xml",downloadPdfUrl:"/chapter/pdf-download/16329",previewPdfUrl:"/chapter/pdf-preview/16329",totalDownloads:2527,totalViews:157,totalCrossrefCites:0,totalDimensionsCites:2,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:52,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"October 8th 2010",dateReviewed:"March 25th 2011",datePrePublished:null,datePublished:"July 27th 2011",dateFinished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/16329",risUrl:"/chapter/ris/16329",book:{id:"519",slug:"chemistry-emission-control-radioactive-pollution-and-indoor-air-quality"},signatures:"M.D. Larrañaga, E. Karunasena, H.W. Holder, E.D. Althouse and D.C. Straus",authors:[{id:"24720",title:"Prof.",name:"David",middleName:null,surname:"Straus",fullName:"David Straus",slug:"david-straus",email:"david.straus@ttuhsc.edu",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Texas Tech University Health Sciences Center",institutionURL:null,country:{name:"United States of America"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Materials and methods",level:"1"},{id:"sec_3",title:"3. Results",level:"1"},{id:"sec_3_2",title:"3.1. Total outside vs. total indoor concentrations (2005 data)",level:"2"},{id:"sec_4_2",title:"3.2. Total outside vs. total indoor concentrations (2006 data)",level:"2"},{id:"sec_4_3",title:"3.2.1. AHU 17",level:"3"},{id:"sec_5_3",title:"3.2.2. AHU 19",level:"3"},{id:"sec_6_3",title:"3.2.3. AHU 21",level:"3"},{id:"sec_8_2",title:"3.3. Air sampling indicators of indoor iontamination",level:"2"},{id:"sec_9_2",title:"3.4. Tests for biodiversity",level:"2"},{id:"sec_11",title:"4. Sampling interpretation summary",level:"1"},{id:"sec_11_2",title:"4.1. Fungal samples",level:"2"},{id:"sec_11_3",title:"4.1.1. Aspergillus species",level:"3"},{id:"sec_12_3",title:"4.1.2. Penicillium species",level:"3"},{id:"sec_13_3",title:"4.1.3. Yeasts",level:"3"},{id:"sec_15_2",title:"4.2. Bacterial samples",level:"2"},{id:"sec_15_3",title:"4.2.1. Actinomycetes",level:"3"},{id:"sec_18",title:"5. Surface sampling interpretation and health risk model",level:"1"},{id:"sec_19",title:"6. Discussion and hypothesis testing",level:"1"},{id:"sec_20",title:"7. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'ACGIH\n\t\t\t\t\t1999 Bioaerosols: Assessment and Control. 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In the late 1950s, the Transient Reactor Test facility (TREAT) was designed, constructed, and commissioned within the span of only a few years [1]. The facility was built just over 1 km away from the Experimental Breeder Reactor-II (EBR-II) sodium-cooled fast breeder reactor as part of the Argonne National Laboratory West campus (ANL-W) located in the Arco Desert, west of Idaho Falls, Idaho. As with most facilities at ANL-W, TREAT was originally envisioned to help support research and development pertaining to EBR-II, but its mission diversified in later years to support other nuclear technology areas. TREAT was a specialized graphite-based test reactor able to safely perform extreme transient power maneuvers to research the effects of postulated accident conditions on nuclear fuel specimens placed in its core [2, 3]. A modern aerial image of TREAT is shown in Figure 1.
Figure 1.
Modern day aerial image of TREAT.
TREAT’s unique abilities stem from its fuel assemblies, in which uranium oxide, graphite, and carbon powders are mixed with binders, pressed into blocks, and fired at high temperatures [4]. The resulting fuel blocks were stacked inside zircaloy-3 sheet metal canisters (a uniquely oxidation-resistant zirconium alloy that was being researched at the time, but which is no longer in production, having been superseded by other zirconium alloys for light-water reactor [LWR] use). These canisters were evacuated and sealed. Aluminum sheaths and end fitting hardware were fastened to the tops and bottoms of these fuel assemblies to house graphite reflectors and provide mechanical interfaces for gridplate placement and handling. These fuel assemblies had a ~10 cm2 cross section with 0.6 m of unfueled axial reflector top and bottom with 1.2 m of active fueled length in the center. Various special fuel and graphite dummy assemblies were also produced, including some with central cylindrical cavities for control rods, some with integral thermocouples, and some with a void region (i.e., containing no fuel or moderator) in the core’s axial center (see Figure 2) [5].
Figure 2.
Historic image of TREAT fuel assembly types.
The resulting fuel assemblies were produced in sufficient quantity to fill the reactor’s 19 × 19 square-pitch gridplate array. Despite thousands of reactor startup and transient cycles over the decades that followed, the fluence experienced during short transients was small, and these same fuel assemblies accumulated very little burnup. Hence, TREAT operates to this day using the original fuel assemblies produced in the 1950s. Occasionally, these fuel assemblies are shuffled into different reactor positions or stored below grade in adjacent storage holes. Core reconfigurations are performed to optimize the core parameters for experimental needs rather than to equilibrate burnup as is typical of most nuclear reactor shuffling schemes. The radionuclide inventory of these fuel assemblies is minimal, and they can be handled without shielding, especially after an extended decay period between transient operations. Still, these fuel assemblies are typically handled in a lead-shielded cask outside the reactor to reduce personnel radiation exposure.
TREAT’s active core region resided just above ground level. The reactor is surrounded by a thick wall of graphite reflector blocks. TREAT’s graphite reflector is surrounded by thick walls of concrete that comprise both the reactor’s main structural shell and its radiation shielding. Blocks can be removed from some parts of the graphite reflector and concrete shielding to create a void slot for viewing the core center from each of the four cardinal directions. Presently, the west slot is occupied by a collimated-beam neutron radiography facility adjacent to the reactor. The north slot is occupied by the Fuel Motion Monitoring System (FMMS), also known as the hodoscope. The east slot area is filled with normal fuel assemblies with a large graphite region in the concrete wall and rolling shield door give access to a highly thermalized neutron environment referred to as the thermal column. The south slot is currently unused, but could be outfitted with other scientific instruments or facilities in the future.
The concrete walls support a ~30 cm-thick circular upper shield plug approximately 3 m in diameter. This shield plug can rotate 360 degrees on bearings via a gear drive. A rectangular slot through the shield plug extends from its center to its periphery. All fuel assemblies, experiments, and other hardware are installed in TREAT through this slot, using bottom loading shielded casks and/or overhead cranes. A ~1 m gap between the top of the fuel assemblies and the bottom of the rotating shield plug provides space for TREAT’s control rods to protrude above the core. See Figures 3 and 4 for an overview of some of the reactor’s key features.
Figure 3.
Section view of TREAT’s key reactor features [6].
Figure 4.
Top view of TREAT’s core, reflector, and shielding layout [6].
Apart from experimental devices that may contain various liquids to support the desired specimen boundary conditions, TREAT does not house liquid coolant for the reactor itself. Instead, a blower system pulls air from the reactor building through debris filters located atop the reactor, down into the core (primarily through ~1 cm2 coolant channel gaps where the corner chamfers of four fuel assembly canisters meet), and out through a filtration system and stack. This air-cooling system is adequate to enable the reactor to operate in low-level steady-state (LLSS) mode for several hours at a time. Presently, TREAT is authorized to operate in LLSS mode at up to 120 kW thermal power, but this power level does not challenge facility physical limitations and could likely be uprated if needed. LLSS mode is useful for calibrations, system check outs, dosimeter irradiations, and neutron radiography. This cooling system is inadequate for removing significant heat within the time duration of a fast transient; hence, it is not credited for transient safety calculations. Therefore, the core’s heat capacity and high-temperature oxidation of fuel assembly canisters typically set the core transient energy capacity at around 2500 MJ, depending on the core configuration. The cooling system also helps cool down the core after large transients, thus boosting operational efficiency. In this manner, TREAT can typically perform one large transient per day—and occasionally two moderate-energy transients in a one-day shift.
TREAT’s unique core design is complimented by its specialized control rod systems, thus enabling its unparalleled transient capabilities. All TREAT’s control rod types use boron carbide in the absorber section, along with graphite-filled zirconium alloy followers. Reactor operation is initiated by withdrawing compensation and transient rod sets (the compensation rods’ purpose is to ensure that hold-down reactivity margins are maintained during the removal of large experiment devices, many of which are net neutron sinks). The reactor is then brought critical by moving the control/shutdown rod sets out of the active core. LLSS operations are typically performed with the rods in this configuration. Transient control rods can then be inserted incrementally to prepare for transient operations, while the control/shutdown rods are withdrawn to maintain criticality until the desired excess reactivity is available in the transient rods. The reactor is then switched into transient mode, and a preprogrammed transient power shape is executed by an automatically controlled computer system with active feedback from ion chamber neutron detectors located in TREAT’s concrete shielding. See Figure 5 for an example core map showing these control rod locations.
Figure 5.
Example core map showing current control rod types and locations.
Transient rods are driven by fast-acting hydraulics in the TREAT basement sub-pile room (see Figure 6). These rod drives can move the rods at a velocity of ~3.5 m/s in both directions (i.e., up and down), permitting split-second manipulation of the reactor’s power shape. A tremendous number of transient shapes can be executed, including prompt pulses, ramps, flattop regions, and combinations thereof [7]. (See Figure 7 for examples of possible power shapes in TREAT.) Transient operation can be “clipped,” based on the desired test conditions, by rapidly inserting the transient control rods to narrow the TREAT natural pulse width to <90 ms (full width at half max) and terminate the reactor power. Further upgrades are planned for expanding TREAT’s clipping capability to include even narrower pulses when needed [8].
Figure 6.
View of TREAT rod drive mechanisms from the sub-pile room.
Figure 7.
Example transient shapes possible at TREAT.
Under certain conditions, a state-of-the-art reactor trip system will initiate the rapid insertion of all rods; however, as with the air-cooling system, the trip system is not credited in the reactor safety basis. Instead, TREAT’s strong negative temperature feedback behavior is credited as the primary means of limiting transient energy. Since TREAT’s uranium oxide particles are dispersed in the fuel blocks, power excursions cause the moderator temperature to rise, resulting in higher neutron energy, increased neutron leakage, and self-limiting power excursions with reliable negative temperature reactivity coefficients. This key feature of TREAT enables it to safely perform research on nuclear fuel specimens under extreme conditions.
2. Facility history
The Arco Desert, where TREAT and ANL-W were built, has also housed many other test reactors as part of the National Reactor Testing station and Naval Reactor Facility missions. A series of water-based transient test reactors were constructed under the Special Power Excursion Reactor Test (SPERT) program that was contemporary to TREAT in its early years [9]. Together, SPERT and TREAT used water capsules to conduct most of the foundational research on overpower fuel performance thresholds for LWRs. During this time, TREAT also continued to perform research on sodium fast reactor (SFR) fuels and nuclear thermal propulsion (NTP) fuels using specialized test capsules. Later, two additional landmark facilities were built out in the Arco Desert to advance research on the accident behavior of LWR fuels. The Power Burst Facility (PBF) offered unrivaled capabilities for reactivity-initiated-accident testing of fuel rods in an integral pressurized flowing loop [10], while the Loss-of-Fluid Test Facility (LOFT) addressed system-scale safety testing via its seminal work in loss-of-coolant-accident testing [11]. These features, along with the postmortem exams performed by facilities in the Arco Desert on fuel from the Three Mile Island accident made Idaho the nexus of fuel safety research throughout the 1980s.
With PBF and LOFT focusing on LWR safety research TREAT’s latter historic era naturally shifted toward a focus on SFR fuels using clever sodium loop test vehicles. The Mk-series loops could test bundles of up to seven pins using compact electromagnetic pumps to recirculate sodium through a small pipe weldment [12]. The entirety of these loops was small and self-contained to foster transportation between TREAT and the adjacent Hot Fuel Examination Facility (HFEF) on the main ANL-W campus. Casks established for this purpose could house sodium loops and other experiments measuring up to 25 cm in diameter by 3.6 m tall. HFEF was used to assemble fuel pins irradiated in other test reactors (e.g., EBR-II) into these TREAT test loops, and to extract/examine these pins after transient irradiation. Today, HFEF remains in operation as a global hub for post-irradiation examinations.
Unlike reactors such as PBF, TREAT was not designed from the ground up with integral piping for test loops. Thus, the most common type of TREAT experiment design is well represented by the successful Mk-series sodium loops. Referred to as package- or cartridge-type experiments, this design approach used a compact, robust, experiment containment vessel to provide the desired specimen boundary conditions and contain all chemical, radiological, and mechanical hazards associated with the test (see Figure 8). These devices, which fit entirely within casks, were installed by being lowered into the reactor and then connected to power/signal lead on the top flange. These leads were routed through the slot in the rotating shield plug and to the necessary control and data acquisition equipment. The absence of liquid coolant or pressure vessel surrounding the reactor simplified lead routing for facilitating transient tests in which real-time experiment data was crucial for understanding the data objectives. This package-type approach was key for enabling TREAT to address specimen coolant conditions and research needs for a variety of reactor designs [13].
Figure 8.
Historic images of Mk-series sodium loop designs.
TREAT performed numerous tests on oxide-type SFR fuel designs in Mk-series loops to produce much of foundational transient behavior data for these systems. The TREAT facility was upgraded in numerous ways to enable testing of larger oxide fuel bundles in an upsized sodium loop in order to address further data gaps, but shifts in national research priorities prevented this upgrade project from being fully completed. The major upgrades that were realized included a larger building with increased crane capabilities and experiment storage holes, modernization of the automatic reactor control system, and reconfiguration/upgrading of the control rod configuration for the reactor trip system (described earlier). While the upsized sodium loop was never deployed, a special set of new TREAT driver fuel assemblies was also fabricated—using higher uranium loading and Inconel canisters to support higher temperature operation—in an inner converter ring meant to increase the fast neutron flux delivered to the test. These new upgrade driver fuel assemblies remain unused in storage at TREAT to this day.
TREAT was upgraded and maintained in state-of-the-art condition up through the early 1990s. By this time, SPERT, PBF, and LOFT had all ceased operation. TREAT continued to perform work related to SFR metallic fuel until funding was canceled for the Integral Fast Reactor Program in the mid-1990s, causing both TREAT and EBR-II to cease operation. EBR-II was eventually decommissioned, and unique specimens irradiated therein were placed in storage to await future use. However, TREAT’s unique, simple design required virtually no maintenance to remain in a safe condition. As a result, electrical power to TREAT’s control rod drive systems was simply disconnected to ensure it could not operate, fuel was left in the reactor, and it remained unchanged in this state for approximately 20 years.
Owing to its floorspace, vertical headroom, and authorization as a nuclear facility, TREAT was still used throughout these years for various other nuclear research applications, but the reactor itself was not operated. These efforts required TREAT to remain in active status and maintain its safety basis authorization. Throughout this period, occasional efforts surfaced to champion the resumption of reactor operations at TREAT [14], but none garnered enough momentum to realize this goal. The events of Fukushima Daiichi in 2011, however, gave rise to renewed interest in developing and researching enhanced safety characteristics for nuclear fuels. The U.S. Accident Tolerant Fuels (ATF) program was launched shortly thereafter and, along with the other mission needs that had accumulated over the years, finally justified the resources needed to resume reactor operations at TREAT [15].
The TREAT restart project then followed. The entirety of the TREAT restart project is summarized in a journal special issue in Ref. [16]. Articles from this special issue are referenced throughout this paper as appropriate. The facility was thoroughly characterized and refurbished as needed, with a focus on age-related degradation of systems and components. In some cases, basic industrial equipment in the plant was replaced or repaired, but most of the plant’s systems were found in good working order. Key staff previously involved in TREAT operation, many of whom had since retired, rallied to this project to train new staff and transfer knowledge. The facility’s safety basis authorization was updated and modernized to reflect new standards and needs [17]. As a testament to the facility’s simplicity, the orderly way it was shut down, and the dedication of the restart project staff, TREAT achieved its “second first-criticality” in 2017 [18]—both ahead of schedule and under budget [19].
A few years prior to TREAT’s restart, contractor reorganization caused the ANL-W campus, along with its key facilities (i.e., TREAT and HFEF), to come under the same management structure responsible for operating many other key nuclear research assets, including the Advanced Test Reactor (ATR). The resulting national laboratory was termed the Idaho National Laboratory (INL). Upon TREAT’s successful restart, INL attained a powerful partnership in research reactor facilities (e.g., a high-flux thermal spectrum material test reactor [ATR], a multipurpose transient test reactor [TREAT], and a sizeable hot cell with abilities to examine and transfer specimens between these reactors [HFEF]) (Figure 9).
Figure 9.
Modern-day aerial view of INL’s materials and fuels complex. (ATR is just out of view on the left side, ~30 km west of TREAT).
3. Current efforts and future outlook
Efforts to prepare for transient experiments began shortly after the TREAT restart project commenced. The FMMS detectors were refurbished, and its data acquisition system was replaced with a modern digital system at this time. The FMMS works as fast neutrons born in the experimental fuel specimens travel through the experiment’s containment structure, the core’s void “slotted” assemblies, and one of several slits in a collimator installed in the reactor’s concrete shielding. A fast neutron detector resides at the end of each slit. The slits are arrayed to focus on different axial and transverse locations in the experiment cavity. The FMMS detectors interact with fast neutrons to cause scintillation and luminescence. This phenomenon is proportional to the number of fast neutron interactions, becomes amplified by photomultiplier tubes, and is converted into an electrical signal for high-speed digital data acquisition. This FMMS is able to observe the location of test fuel throughout the duration of the transient. Phenomena such as the expansion, disruption, and meltdown of test fuel can be observed in real time by the FMMS. A cross-section image of the FMMS can be seen in Figure 10.
Figure 10.
FMMS cross section of collimator/detector locations and the reactor shielding interface [20].
Similarly, the new digital experiment data acquisition and control system (EDACS) was installed. EDACS relies on commercially available equipment and is designed with modularity and expandability to support new instrumentation and control system functions. Dedicated controllers work redundantly with this system to ensure that functions significant to safety are highly reliable (e.g., overtemperature control of electric heaters for heating experiments prior to transient operation). Similarly, wire routing options and facility locations were established for special-purpose signal processing and data acquisition equipment to support special test sensors that do not require integration with EDACS.
In the years preceding its restart, numerous experimenters had expressed interest in using TREAT. The interests of these users encompassed LWR-, SFR-, and NTP-type reactors. A new test system, referred to as the Minimal Activation Retrievable Capsule Holder (MARCH), was designed to fulfill these various research needs shortly after resuming reactor operations. The MARCH system took inspiration from historic package-type experiments by using a stainless-steel containment pipe weldment, inside a sheet metal enclosure, referred to as the Broad Use Specimen Transient Experiment Rig (BUSTER). BUSTER can be handled, installed, and connected to support leads in the same way as the Mk-series loops. However, the MARCH system departed from the historic approach in that the sealed capsules are placed inside its pipe. Since many of the first fuel technologies tested in TREAT were emerging (e.g., ATF specimens), only fresh fuel specimens were available. Hence, by combining this capsule-in-pipe mechanical layout with capsule materials that do not transmute into significant radioisotopes (principally titanium alloys), the MARCH system enabled fresh fuel capsules to be irradiated, removed from BUSTER on the TREAT working floor by using the storage holes, and shipped for post-transient exams using glovebox facilities, all in a matter of weeks. A detailed characterization of the BUSTER nuclear environment was performed via Monte Carlo neutronics modeling and can be found in [21]. This approach enables BUSTER to function as a reusable device manufactured in accordance with exacting pressure vessel code and quality assurance requirements, whereas capsules are typically treated as consumable hardware with function-specific engineering requirements. This strategy helps reduce costs as well as the design innovation cycles between test series and capsule adaptations.
The inaugural irradiations performed in BUSTER were sponsored by the ATF program and featured LWR rodlets composed of UO2 pellets in zirconium-alloy cladding. These tests used a helium environment capsule design known as the Separate Effects Test Holder (SETH). These tests focused on quantifying core-to-specimen energy coupling factors, commissioning new experiment support systems such as EDACS, demonstrating use of the FMMS, and assessing the performance of instrumentation in concurrent tests placed in TREAT coolant channel positions [22]. The SETH tests hosted new technologies for world first applications in transient testing, including additively manufactured capsules and multispectral pyrometry. Post-transient exams were performed as intended using a glovebox facility [23], and a second round of capsules were irradiated shortly thereafter on ATF technologies including as U3Si2 fuel pellets and silicon carbide composite cladding [24]. The design was adapted to perform power ramp testing on unclad ceramic fuel specimens inside solid metal holders acting as heat sinks to create thermomechanical gradients in order to investigate transient fuel fracture behaviors.
Building on the successes of the SETH series of experiments, three new major capsule categories were created to provide more prototypic specimen boundary conditions. One capsule was created to support new NTP fuel specimen testing in the SIRIUS series of experiments. The SIRIUS capsule design can house hydrogen in its gas environment, as well as support repeated high-temperature irradiations. The SIRIUS capsule has been used to perform repeated power ramps and to measure specimen temperatures ranging from room temperature to well beyond 2000°C in order to simulate NTP engine startup cycles.
Another capsule, termed the Static Environment Rodlet Transient Test Apparatus (SERTTA), was created to house pressurized water environments for reactivity-initiated-accident testing on LWR rodlets. To date, several studies have been performed using SERTTA, including a series of tests focused on the elucidation of in-reactor transient critical heat flux boiling behavior, and aided by a novel electro-impedance sensor able to detect water voiding in real time [25]. The SERTTA capsule was also recently used to test an LWR rodlet previously irradiated in the ATR. This test marked the first modern use of HFEF to assemble TREAT experiments. Tests assembled in HFEF are expected to become prevalent as more previously irradiated specimens become available for end-of-life fuel safety testing.
A new sodium capsule, referred to as the Temperature Heat-Sink Overpower Response (THOR) capsule, was very recently designed and underwent commissioning tests in TREAT. THOR’s key feature is a thick-walled metal heat sink surrounding the specimen. Embedded electrical heaters liquify sodium between the heat sink and test pin cladding prior to transient operation. The liquid sodium enables tight thermal coupling between the pin and heatsink. Working in concert with TREAT’s flexible transient power-shaping capability, THOR can simulate transient overpower temperature responses in test pins. THOR can house up to a single full-length EBR-II rod and is currently being prepared for a test series using legacy rods irradiated in EBR-II that were retained for many decades for this very purpose. See Figure 11 for an overview of the test capsules currently used in the MARCH system at TREAT.
Figure 11.
Overview of MARCH system and experiment capsules used to date.
As of 2021, TREAT offers a variety of experiment capabilities and capsules for testing fuel specimens in water, liquid metal, inert gas, and NTP reactor environments. As the only remaining U.S. transient test reactor with significant fuel testing capabilities, TREAT’s mission in the modern era remains as diverse as ever. Still, TREAT and its supporting infrastructure are not yet as capable as they were in the past, especially considering that TREAT must now absorb missions that would historically have been addressed by other reactors. This need is particularly important for test devices able to house larger specimens/bundles and actively manipulate thermal hydraulic conditions. For this reason, a new enlarged version of BUSTER (i.e., Big-BUSTER) has been engineered and slated for deployment in TREAT in 2022. Big-BUSTER allows for test devices up to 20 cm in diameter (as opposed to the 6 cm available in BUSTER), and is constructed from a zirconium alloy to afford increased neutron flux to the test device.
Currently, Big-BUSTER is planned to house an enhanced pressurized water capsule. This capsule is based on a design originally intended to fit in BUSTER with a water blowdown tank to simulate LWR loss-of-coolant accidents [26] but enlarged and adapted to Big-BUSTER for larger test rods. Hot-cell-based equipment is currently under development to enable full-length LWR rods to be cropped, rewelded/pressurized, and outfitted with instrumentation to support such tests. The historic Mk-series sodium loop was also updated to feature modern components and adapted to fit within Big-BUSTER. This new sodium loop will be used to irradiate SFR specimens and small bundles, including longer pins historically irradiated in the now-decommissioned Fast Flux Test Facility. These pins were shipped to INL decades ago and retained for many years to address transient data needs. Other test devices currently under development involve plans to use Big-BUSTER for enhanced test environment simulation. Notable projects planned for deployment include a flowing hydrogen loop for testing advanced NTP fuels, and a helium gas-cooled device for testing microreactor and other gas-cooled reactor technologies. Based on this trajectory, TREAT is expected to continue expanding its capabilities and missions to likely become the longest lived and most versatile transient test reactor ever constructed.
\n',keywords:"transient testing, fuel safety research, accident simulation",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/79646.pdf",chapterXML:"https://mts.intechopen.com/source/xml/79646.xml",downloadPdfUrl:"/chapter/pdf-download/79646",previewPdfUrl:"/chapter/pdf-preview/79646",totalDownloads:99,totalViews:0,totalCrossrefCites:0,dateSubmitted:"October 14th 2021",dateReviewed:"October 18th 2021",datePrePublished:"December 13th 2021",datePublished:null,dateFinished:"December 13th 2021",readingETA:"0",abstract:"Constructed in the late 1950s, the Transient Reactor Test facility (TREAT) provided numerous transient irradiations until operation was suspended in 1994. It was later refurbished, and resumed operations in 2017 to meet the data needs of a new era of nuclear fuel safety research. TREAT uses uranium oxide dispersed in graphite blocks to yield a core that affords strong negative temperature feedback. Automatically controlled, fast-acting transient control rods enable TREAT to safely perform extreme power maneuvers—ranging from prompt bursts to longer power ramps—to broadly support research on postulated accidents for many reactor types. TREAT’s experiment devices work in concert with the reactor to contain specimens, support in situ diagnostics, and provide desired test environments, thus yielding a uniquely versatile facility. This chapter summarizes TREAT’s design, history, current efforts, and future endeavors in the field of nuclear-heated fuel safety research.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/79646",risUrl:"/chapter/ris/79646",signatures:"Nicolas Woolstenhulme",book:{id:"10982",type:"book",title:"Nuclear Reactors",subtitle:null,fullTitle:"Nuclear Reactors",slug:null,publishedDate:null,bookSignature:"Prof. Chad L. Pope",coverURL:"https://cdn.intechopen.com/books/images_new/10982.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-940-5",printIsbn:"978-1-83969-939-9",pdfIsbn:"978-1-83969-941-2",isAvailableForWebshopOrdering:!0,editors:[{id:"324562",title:"Prof.",name:"Chad L.",middleName:null,surname:"Pope",slug:"chad-l.-pope",fullName:"Chad L. Pope"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Facility history",level:"1"},{id:"sec_3",title:"3. Current efforts and future outlook",level:"1"}],chapterReferences:[{id:"B1",body:'TREAT History. Available from: https://transient.inl.gov/SitePages/TREAT%20History.aspx [Accessed: September 25, 2021]'},{id:"B2",body:'Mcfarlane DR, Freund GA, Boland JF. Hazards Summary Report on the Transient Reactor Test Facility (TREAT). ANL-5923. 1958'},{id:"B3",body:'Freund GA, Iskendarian HP, Okrent D. TREAT a Pulsed Graphite-Moderated Reactor for Kinetics Experiments. In: Proc. 2nd United Nations Int. Conf. on the Peaceful Uses of Atomic Energy; Geneva, Switzerland. Vol. 10. 1958. p. 461'},{id:"B4",body:'Handwerk JH, Lied RC. The Manufacture of the Graphite-Urania Fuel Matrix for TREAT. ANL-5963. 1960'},{id:"B5",body:'TREAT Baseline Description Document. ANL/RAS-72-73. Argonne National Laboratory; 1972'},{id:"B6",body:'Bess JD, Dehart MD. Baseline Assessment of TREAT for Modeling and Analysis Needs. INL/EXT-15-35372. Idaho National Laboratory; 2015'},{id:"B7",body:'Holschuh T, Woolstenhulme N, Baker B, Bess J, Davis C, Parry J. Transient reactor test facility advanced transient shapes. Nuclear Technology. 2019;205(10):1346-1353'},{id:"B8",body:'Bess JD, Woolstenhulme NE, Davis CB, Dusanter LM, Folsom CP, Parry JR, et al. Narrowing transient testing pulse widths to enhance LWR RIA experiment design in the TREAT facility. Annals of Nuclear Energy. 2019;124:548-571'},{id:"B9",body:'Grund JE, et al. Subassembly Test Program Outline for FY 1969 and 1970, IN-1313, IDO-17277. Idaho Nuclear Corporation; 1969'},{id:"B10",body:'Spencer WA, Jensen AM, McCardell RK. Capabilities of the power burst facility. In: Proc. Int. Topl. Mtg. Irradiation Technology; September 28-30, 1982. pp 175-198. Available from: https://link.springer.com/chapter/10.1007%2F978-94-009-7115-8_13'},{id:"B11",body:'Modro SM, et al. Review of LOFT Large Break Experiments. NUREG/IA-0028. U.S. Nuclear Regulatory Commission; 1989'},{id:"B12",body:'Wright AE, et al. Mark-III integral sodium loop for LMFBR safety experiments in treat. In: Proc. Conf. on Fast, Thermal, and Fusion Reactor Experiments; Salt Lake City, Utah: American Nuclear Society; April 12-15, 1982. Vol. 1. 1982'},{id:"B13",body:'Woolstenhulme N, Baker C, Jensen C, Chapman D, Imholte D, Oldham N, et al. Development of irradiation test devices for transient testing. Nuclear Technology. 2019;205(10):1251-1265'},{id:"B14",body:'Crawford DC, Swanson RW. RIA testing capability of the transient reactor test facility (IAEA-TECDOC--1122). International Atomic Energy Agency (IAEA). 1999. Available from: https://inis.iaea.org/search/search.aspx?orig_q=RN:30057719'},{id:"B15",body:'Wachs DM. Transient testing of nuclear fuels and materials in the United States. Journal of the Minerals Metals and Materials Society. 2012;64(12):1396'},{id:"B16",body:'Special issue on restarting the transient reactor test facility. Nuclear Technology. 2019;205:10'},{id:"B17",body:'Gerstner DM, Parry JR, Broussard DJ, Moon BL, Laporta AW, Forshee CP, et al. Safety strategy and update of the TREAT facility safety basis. Nuclear Technology. 2019;205(10):1266-1289'},{id:"B18",body:'Laporta AW. Transient reactor test (TREAT) facility initial approach to restart criticality following extended standby operation. Nuclear Technology. 2019;205(10):1290-1301'},{id:"B19",body:'Heath BK, Cody CRACE. TREAT restart project. Nuclear Technology. 2019;205(10):1369-1377'},{id:"B20",body:'Thompson SJ, Johnson JT, Schley RS, Townsend CH, David LC. Preliminary modeling to support the TREAT hodoscope system for fuel motion monitoring. In: Proc. Int. Conf. PHYSOR 2016; Sun Valley, ID; American Nuclear Society; May 1-5, 2016. Available from: https://inldigitallibrary.inl.gov/sites/sti/sti/Sort_8873.pdf'},{id:"B21",body:'Bess JD, Woolstenhulme NE, Jensen CB, Parry JR, Hill CM. Nuclear characterization of a general-purpose instrumentation and materials testing location in TREAT. Annals of Nuclear Energy. 2019;124:270-294'},{id:"B22",body:'Woolstenhulme N, Fleming A, Holschuh T, Jensen C, Kamerman D, Wachs D. Core-to-specimen energy coupling results of the first modern fueled experiments in TREAT. Annals of Nuclear Energy. 2020;140:107117'},{id:"B23",body:'Schulthess J, Woolstenhulme N, Craft A, Kane J, Boulton N, Chuirazzi W, et al. Non-Destructive post-irradiation examination results of the first modern fueled experiments in TREAT. Journal of Nuclear Materials. 2020;541:152442'},{id:"B24",body:'Kamerman D, Woolstenhulme N, Imholte D, Fleming A, Jensen C, Folsom C, et al. Transient testing of uranium silicide fuel in zircaloy and silicon carbide cladding. Annals of Nuclear Energy. 2021;160:108410'},{id:"B25",body:'Armstrong RJ, Folsom CP, Fleming AD, Jensen CB. Results of the CHF-SERTTA in-pile transient boiling experiments at TREAT. In: Proceedings of TopFuel 2021; Santander, Spain: American Nuclear Society; 10/24/2021-10/28/2021. INL/CON-21-64083. 2021. Available from: https://www.osti.gov/servlets/purl/1820615'},{id:"B26",body:'Woolstenhulme N, Jensen C, Folsom C, Armstrong R, Yoo J, Wachs D. Thermal-hydraulic and engineering evaluations of new LOCA testing methods in TREAT. Nuclear Technology. 2021;207(5):637-652'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Nicolas Woolstenhulme",address:"nicolas.woolstenhulme@inl.gov",affiliation:'
Idaho National Laboratory, Idaho Falls, Idaho, United States
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",metaTitle:"What Does It Cost?",metaDescription:"Open Access publishing helps remove barriers and allows everyone to access valuable information, but article and book processing charges also exclude talented authors and editors who can’t afford to pay. The goal of our Women in Science program is to charge zero APCs, so none of our authors or editors have to pay for publication.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"
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All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
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Bill and Melinda Gates Foundation
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National Science Foundation (NSF)
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We are currently in the process of collecting sponsorship. If you have any ideas or would like to help sponsor this ambitious program, we’d love to hear from you. Contact us at info@intechopen.com.
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All of our IntechOpen sponsors are in good company! The research in past IntechOpen books and chapters have been funded by:
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European Commission
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Bill and Melinda Gates Foundation
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Wellcome Trust
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National Institute of Health (NIH)
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National Science Foundation (NSF)
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Research Councils United Kingdom (RCUK)
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Foundation for Science and Technology (FCT)
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Chinese Academy of Sciences
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Natural Science Foundation of China (NSFC)
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German Research Foundation (DFG)
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Max Planck Institute
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Austrian Science Fund (FWF)
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From the medicinal point of view, biomarkers present in EBC depict rather the processes occurring in lungs than those in the entire system. Therefore, particular profiles of exhaled biomarkers (e.g. cys-LTs, LTB4, 8-isoprostane, etc.) apparently reveal information exclusively applicable to differential lung disease diagnoses. This chapter describes the developed analytical method being applied to a clinical study for differential diagnostics of various phenotypes of asthma, chronic obstructive pulmonary disease, lung cancer, etc. In particular, having determined cys-LTs and LXs by the described method, and having applied them as biomarkers of bronchial asthma, their distinctive potential was demonstrated to differentially diagnose the specific disease, clearly suggesting this method to be reckoned as a beneficial alternative to existing diagnostic methods. Consecutively, the developed method was expanded to other asthma markers as aldehydes, nitrotyrosine, 8-isoprostane, PGE2, adenosine and finally, a supplementary study was carried out, engaging in detecting serotonin. The multi-marker screening and importance in the diagnostics of pulmonary diseases are referenced in the text as well.",book:{id:"6566",slug:"biomarker-indicator-of-abnormal-physiological-process",title:"Biomarker",fullTitle:"Biomarker - Indicator of Abnormal Physiological Process"},signatures:"Tereza Kačerová, Petr Novotný, Ján Boroň and Petr Kačer",authors:[{id:"190932",title:"Associate Prof.",name:"Petr",middleName:null,surname:"Kačer",slug:"petr-kacer",fullName:"Petr Kačer"},{id:"197652",title:"Ms.",name:"Tereza",middleName:null,surname:"Kacerova",slug:"tereza-kacerova",fullName:"Tereza Kacerova"},{id:"207204",title:"Dr.",name:"Petr",middleName:null,surname:"Novotný",slug:"petr-novotny",fullName:"Petr Novotný"},{id:"207205",title:"Dr.",name:"Ján",middleName:null,surname:"Boroň",slug:"jan-boron",fullName:"Ján Boroň"}]},{id:"61381",title:"Internet of Things in Emergency Medical Care and Services",slug:"internet-of-things-in-emergency-medical-care-and-services",totalDownloads:1954,totalCrossrefCites:7,totalDimensionsCites:9,abstract:"Emergency care is a critical area of medicine whose outcomes are influenced by the time, availability, and accuracy of contextual information. In addition, the success of emergency care depends on the quality and accuracy of the information received during the emergency call and data collected during the emergency transportation. The success of a follow medical treatment at an emergency care unit depends too on data collected during the two phases: emergency call and transport. However, most information received during an emergency-call is inaccurate and the process of information collection, storage, processing, and retrieval, during an emergency-transportation, is remaining manual and time-consuming. Emergency doctors mostly lack patient’s health records and base the medical treatment on a set of collected information including information provided by the patient or his relatives. Hence, the emergency care delivery is more patient-centered than patient-centric information. Wireless body area network and Internet of Technology (IoT) enable accurate collection of data and are increasingly used in medical applications. This chapter discusses the challenges facing the emergency medical care services delivery, especially in the developing countries. It presents and discusses an IoT platform for a patient-centric-information-based emergency care services delivery. The study is focused on a case of road traffic injury. Results of conducted experiments are discussed.",book:{id:"6655",slug:"medical-internet-of-things-m-iot-enabling-technologies-and-emerging-applications",title:"Medical Internet of Things (m-IoT)",fullTitle:"Medical Internet of Things (m-IoT) - Enabling Technologies and Emerging Applications"},signatures:"Thierry Edoh",authors:[{id:"234682",title:"Ph.D.",name:"Thierry",middleName:null,surname:"Edoh",slug:"thierry-edoh",fullName:"Thierry Edoh"}]},{id:"60889",title:"Biomarkers Utility for Sepsis Patients Management",slug:"biomarkers-utility-for-sepsis-patients-management",totalDownloads:1457,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Sepsis is a global problem in either developing or developed countries and it is expected that the number of patients with sepsis and septic shock will tremendously increase in next decades also because of the antibiotic resistance growing issue worldwide. Criteria for sepsis diagnosis and prognosis have been recently established, but still a further understanding of the role of biomarkers in this setting is needed. Better utilization of biomarkers such as white blood cell count, CRP, lactate, procalcitonin, presepsin and bioadrenomedullin in sepsis patients, a state of the art on how to use them is needed. This review will focus on the actual recognized role of sepsis biomarkers not only for diagnosis purpose but also to improve patients treatment results in order to reduce mortality, hospital length of stay and cost related.",book:{id:"6566",slug:"biomarker-indicator-of-abnormal-physiological-process",title:"Biomarker",fullTitle:"Biomarker - Indicator of Abnormal Physiological Process"},signatures:"Agustin Iskandar, Hani Susianti, Muhammad Anshory and Salvatore\nDi Somma",authors:[{id:"187348",title:"Prof.",name:"Salvatore",middleName:null,surname:"Di Somma",slug:"salvatore-di-somma",fullName:"Salvatore Di Somma"},{id:"230421",title:"Dr.",name:"Muhammad",middleName:null,surname:"Anshory",slug:"muhammad-anshory",fullName:"Muhammad Anshory"},{id:"230444",title:"Associate Prof.",name:"Agustin",middleName:null,surname:"Iskandar",slug:"agustin-iskandar",fullName:"Agustin Iskandar"},{id:"230467",title:"Dr.",name:"Hani",middleName:null,surname:"Susianti",slug:"hani-susianti",fullName:"Hani Susianti"}]},{id:"62000",title:"Biomarkers in Breast Cancer",slug:"biomarkers-in-breast-cancer",totalDownloads:1687,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Breast cancer is the most common cancer in women and its incidence experienced an important increase, thanks to the introduction of a systematic screening. The increased incidence of early breast cancer has led to debates on its over-treatment, which may cause unnecessary harm to patients with favorable prognosis. Therefore, modern research is in the quest of finding the perfect prognostic marker to avoid overtreatment in patients with a favorable prognosis. In this perspective, many molecular markers have been studied in the last decades in order to provide both a useful prognostic tool, able to determine whether the cancer is likely to be indolent or aggressive, and a possible therapeutic target. In this chapter, we review the current knowledge about the principal biomarkers, which are usually immunohistochemically tested on breast surgical specimens, including ER and PR, Mib1/Ki-67 and HER2/neu expression. Furthermore, we will analyze other possible prognostic markers which may have in the future a key role in breast cancer management, such as several multigene panels (OncotypeDX, Mammaprint, NanoString Prosigma). Finally, we will discuss the role of genetic tests for some know genetic mutations associated with higher breast cancer susceptibility (BRCA1 and 2 genes).",book:{id:"6566",slug:"biomarker-indicator-of-abnormal-physiological-process",title:"Biomarker",fullTitle:"Biomarker - Indicator of Abnormal Physiological Process"},signatures:"Serena Bertozzi, Ambrogio P Londero, Luca Seriau, Roberta Di Vora,\nCarla Cedolini and Laura Mariuzzi",authors:[{id:"74447",title:"Dr.",name:"Ambrogio P",middleName:null,surname:"Londero",slug:"ambrogio-p-londero",fullName:"Ambrogio P Londero"},{id:"167094",title:"Dr.",name:"Serena",middleName:null,surname:"Bertozzi",slug:"serena-bertozzi",fullName:"Serena Bertozzi"},{id:"234965",title:"Dr.",name:"Roberta",middleName:null,surname:"Di Vora",slug:"roberta-di-vora",fullName:"Roberta Di Vora"},{id:"234970",title:"Prof.",name:"Laura",middleName:null,surname:"Mariuzzi",slug:"laura-mariuzzi",fullName:"Laura Mariuzzi"},{id:"234971",title:"Dr.",name:"Carla",middleName:null,surname:"Cedolini",slug:"carla-cedolini",fullName:"Carla Cedolini"},{id:"235400",title:"Dr.",name:"Luca",middleName:null,surname:"Seriau",slug:"luca-seriau",fullName:"Luca Seriau"}]},{id:"60624",title:"Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Mean Platelet Volume for Detection of Resectable Pancreas Cancer",slug:"neutrophil-lymphocyte-ratio-platelet-lymphocyte-ratio-and-mean-platelet-volume-for-detection-of-rese",totalDownloads:977,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Several biomarkers have been preferred for the early diagnosis of pancreatic adenocancer (PAC), but most are not ready to be included as part of the routine diagnostic algorithm because they still lack sensitivity, specificity or reproducibility. CA19-9 is the most widely used serum-based marker for the diagnosis and follow-up of pancreatic cancer. However, CA19-9 lacks sensitivity for early or small-diameter pancreatic cancers. For more than 3 decades, information on neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) has been widely available to health care practitioners, as part of the data provided in the full blood count. However, these biomarkers have more than used in the routine. The present chapter shares the prognostic significance of the hematological parameters in the light of our own findings and recent studies in the literature.",book:{id:"6566",slug:"biomarker-indicator-of-abnormal-physiological-process",title:"Biomarker",fullTitle:"Biomarker - Indicator of Abnormal Physiological Process"},signatures:"Kemal Turker Ulutas, Inanc Samil Sarici and Ozgul Duzgun",authors:[{id:"213868",title:"Dr.",name:"Samil",middleName:null,surname:"Sarici",slug:"samil-sarici",fullName:"Samil Sarici"},{id:"214666",title:"Dr.",name:"Ozgul",middleName:null,surname:"Duzgun",slug:"ozgul-duzgun",fullName:"Ozgul Duzgun"},{id:"226644",title:"M.D.",name:"Kemal Turker",middleName:null,surname:"Ulutas",slug:"kemal-turker-ulutas",fullName:"Kemal Turker Ulutas"}]}],onlineFirstChaptersFilter:{topicId:"1016",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:31,numberOfPublishedChapters:314,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:18,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:14,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:31,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:2,paginationItems:[{id:"89",title:"Education",coverUrl:"https://cdn.intechopen.com/series_topics/covers/89.jpg",isOpenForSubmission:!1,annualVolume:null,editor:{id:"260066",title:"Associate Prof.",name:"Michail",middleName:null,surname:"Kalogiannakis",slug:"michail-kalogiannakis",fullName:"Michail Kalogiannakis",profilePictureURL:"https://mts.intechopen.com/storage/users/260066/images/system/260066.jpg",biography:"Michail Kalogiannakis is an Associate Professor of the Department of Preschool Education, University of Crete, and an Associate Tutor at School of Humanities at the Hellenic Open University. He graduated from the Physics Department of the University of Crete and continued his post-graduate studies at the University Paris 7-Denis Diderot (D.E.A. in Didactic of Physics), University Paris 5-René Descartes-Sorbonne (D.E.A. in Science Education) and received his Ph.D. degree at the University Paris 5-René Descartes-Sorbonne (PhD in Science Education). His research interests include science education in early childhood, science teaching and learning, e-learning, the use of ICT in science education, games simulations, and mobile learning. 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She has run and participated in several funded and non-funded projects on the teaching of Science, Social Sciences, and ICT in education. She also has the experience of participating in five Erasmus+ projects.",institutionString:"University of Crete",institution:{name:"University of Crete",institutionURL:null,country:{name:"Greece"}}},editorThree:null},{id:"90",title:"Human Development",coverUrl:"https://cdn.intechopen.com/series_topics/covers/90.jpg",isOpenForSubmission:!0,annualVolume:11974,editor:{id:"191040",title:"Dr.",name:"Tal",middleName:null,surname:"Dotan Ben-Soussan",slug:"tal-dotan-ben-soussan",fullName:"Tal Dotan Ben-Soussan",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBf1QAG/Profile_Picture_2022-03-18T07:56:11.jpg",biography:"Tal Dotan Ben-Soussan, Ph.D., is the director of the Research Institute for Neuroscience, Education and Didactics (RINED) – Paoletti Foundation. Ben-Soussan leads international studies on training and neuroplasticity from neurophysiological and psychobiological perspectives. As a neuroscientist and bio-psychologist, she has published numerous articles on neuroplasticity, movement and meditation. She acts as an editor and reviewer in several renowned journals and coordinates international conferences integrating theoretical, methodological and practical approaches on various topics, such as silence, logics and neuro-education. She lives in Assisi, Italy.",institutionString:"Research Institute for Neuroscience, Education and Didactics, Patrizio Paoletti Foundation",institution:null},editorTwo:null,editorThree:null}]},overviewPageOFChapters:{paginationCount:7,paginationItems:[{id:"82405",title:"Does Board Structure Matter in CSR Spending of Commercial Banks? 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He has published research in Research Policy, Applied Economics, Review of Economic Philosophy, Strategic Change, International Journal of Logistics, Sustainability, Journal of Environmental Management, Journal of Global Information Management, Journal of Cleaner Production, M@N@GEMENT, and more. He is a member of CEDIMES Institut (France), Academy of International Business (AIB), Strategic Management Society (SMS), Academy of Management (AOM), Administrative Science Association of Canada (ASAC), and Canadian council of small business and entrepreneurship (CCSBE). He is currently the director of the Research Group on Contemporary Asia (GERAC) at Laval University. He is also co-managing editor of Transnational Corporations Review and a guest editor for Electronic Commerce Research and Journal of Internet Technology.",institutionString:"Université Laval",institution:{name:"Université Laval",institutionURL:null,country:{name:"Canada"}}}]}]},openForSubmissionBooks:{paginationCount:1,paginationItems:[{id:"11478",title:"Recent Advances in the Study of Dyslexia",coverURL:"https://cdn.intechopen.com/books/images_new/11478.jpg",hash:"26764a18c6b776698823e0e1c3022d2f",secondStepPassed:!1,currentStepOfPublishingProcess:2,submissionDeadline:"June 30th 2022",isOpenForSubmission:!0,editors:[{id:"294281",title:"Prof.",name:"Jonathan",surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},onlineFirstChapters:{paginationCount:19,paginationItems:[{id:"82196",title:"Multi-Features Assisted Age Invariant Face Recognition and Retrieval Using CNN with Scale Invariant Heat Kernel Signature",doi:"10.5772/intechopen.104944",signatures:"Kamarajugadda Kishore Kumar and Movva Pavani",slug:"multi-features-assisted-age-invariant-face-recognition-and-retrieval-using-cnn-with-scale-invariant-",totalDownloads:6,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Pattern Recognition - New Insights",coverURL:"https://cdn.intechopen.com/books/images_new/11442.jpg",subseries:{id:"26",title:"Machine Learning and Data Mining"}}},{id:"82063",title:"Evaluating Similarities and Differences between Machine Learning and Traditional Statistical Modeling in Healthcare Analytics",doi:"10.5772/intechopen.105116",signatures:"Michele Bennett, Ewa J. 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\r\n\tIn general, the harsher the environmental conditions in an ecosystem, the lower the biodiversity. Changes in the environment caused by human activity accelerate the impoverishment of biodiversity.
\r\n
\r\n\tBiodiversity refers to “the variability of living organisms from any source, including terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; it includes diversity within each species, between species, and that of ecosystems”.
\r\n
\r\n\tBiodiversity provides food security and constitutes a gene pool for biotechnology, especially in the field of agriculture and medicine, and promotes the development of ecotourism.
\r\n
\r\n\tCurrently, biologists admit that we are witnessing the first phases of the seventh mass extinction caused by human intervention. It is estimated that the current rate of extinction is between a hundred and a thousand times faster than it was when man first appeared. The disappearance of species is caused not only by an accelerated rate of extinction, but also by a decrease in the rate of emergence of new species as human activities degrade the natural environment. The conservation of biological diversity is "a common concern of humanity" and an integral part of the development process. Its objectives are “the conservation of biological diversity, the sustainable use of its components, and the fair and equitable sharing of the benefits resulting from the use of genetic resources”.
\r\n
\r\n\tThe following are the main causes of biodiversity loss:
\r\n
\r\n\t• The destruction of natural habitats to expand urban and agricultural areas and to obtain timber, minerals and other natural resources.
\r\n
\r\n\t• The introduction of alien species into a habitat, whether intentionally or unintentionally which has an impact on the fauna and flora of the area, and as a result, they are reduced or become extinct.
\r\n
\r\n\t• Pollution from industrial and agricultural products, which devastate the fauna and flora, especially those in fresh water.
\r\n
\r\n\t• Global warming, which is seen as a threat to biological diversity, and will become increasingly important in the future.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/40.jpg",keywords:"Ecosystems, Biodiversity, Fauna, Taxonomy, Invasive species, Destruction of habitats, Overexploitation of natural resources, Pollution, Global warming, Conservation of natural spaces, Bioremediation"},{id:"39",title:"Environmental Resilience and Management",scope:"
\r\n\tThe environment is subject to severe anthropic effects. Among them are those associated with pollution, resource extraction and overexploitation, loss of biodiversity, soil degradation, disorderly land occupation and planning, and many others. These anthropic effects could potentially be caused by any inadequate management of the environment. However, ecosystems have a resilience that makes them react to disturbances which mitigate the negative effects. It is critical to understand how ecosystems, natural and anthropized, including urban environments, respond to actions that have a negative influence and how they are managed. It is also important to establish when the limits marked by the resilience and the breaking point are achieved and when no return is possible. The main focus for the chapters is to cover the subjects such as understanding how the environment resilience works, the mechanisms involved, and how to manage them in order to improve our interactions with the environment and promote the use of adequate management practices such as those outlined in the United Nations’ Sustainable Development Goals.
\r\n\tPollution is caused by a wide variety of human activities and occurs in diverse forms, for example biological, chemical, et cetera. In recent years, significant efforts have been made to ensure that the environment is clean, that rigorous rules are implemented, and old laws are updated to reduce the risks towards humans and ecosystems. However, rapid industrialization and the need for more cultivable sources or habitable lands, for an increasing population, as well as fewer alternatives for waste disposal, make the pollution control tasks more challenging. Therefore, this topic will focus on assessing and managing environmental pollution. It will cover various subjects, including risk assessment due to the pollution of ecosystems, transport and fate of pollutants, restoration or remediation of polluted matrices, and efforts towards sustainable solutions to minimize environmental pollution.
\r\n\tWater is not only a crucial substance needed for biological life on Earth, but it is also a basic requirement for the existence and development of the human society. Owing to the importance of water to life on Earth, early researchers conducted numerous studies and analyses on the liquid form of water from the perspectives of chemistry, physics, earth science, and biology, and concluded that Earth is a "water polo". Water covers approximately 71% of Earth's surface. However, 97.2% of this water is seawater, 21.5% is icebergs and glaciers, and only 0.65% is freshwater that can be used directly by humans. As a result, the amount of water reserves available for human consumption is limited. The development, utilization, and protection of freshwater resources has become the focus of water science research for the continued improvement of human livelihoods and society.
\r\n
\r\n\tWater exists as solid, liquid, and gas within Earth’s atmosphere, lithosphere, and biosphere. Liquid water is used for a variety of purposes besides drinking, including power generation, ecology, landscaping, and shipping. Because water is involved in various environmental hydrological processes as well as numerous aspects of the economy and human society, the study of various phenomena in the hydrosphere, the laws governing their occurrence and development, the relationship between the hydrosphere and other spheres of Earth, and the relationship between water and social development, are all part of water science. Knowledge systems for water science are improving continuously. Water science has become a specialized field concerned with the identification of its physical, chemical, and biological properties. In addition, it reveals the laws of water distribution, movement, and circulation, and proposes methods and tools for water development, utilization, planning, management, and protection. Currently, the field of water science covers research related to topics such as hydrology, water resources and water environment. It also includes research on water related issues such as safety, engineering, economy, law, culture, information, and education.
",coverUrl:"https://cdn.intechopen.com/series_topics/covers/41.jpg",keywords:"Water, Water resources, Freshwater, Hydrological processes, Utilization, Protection"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Environmental Sciences",id:"25"},selectedSubseries:null},seriesLanding:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 24th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:4,numberOfPublishedChapters:314,numberOfPublishedBooks:31,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. 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