Emissions and Health Impacts of Biomass Combustion Penn...
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Penn State Bioenergy Short Course Series
Emissions and Health Impacts of Biomass CombustionPenn State University
May 20, 2010
Woodsmoke: Exposure Assessment and Health Effects
Luke P. Naeher, Ph.D.Department of Environmental Health ScienceCollege of Public HealthUniversity of [email protected]
Outline
US Clean Air Act Criteria PollutantsHistoric episodes of air pollutionPM2.5 and CO
WoodsmokeExposures and compositionRelated health effects
Examples of woodsmoke-related researchUS forest firefightersDeveloping world cookstoves
History of Air Pollution Episodes
Meuse Valley, Belgium Meuse Valley, Belgium –– 19301930Donora, Pennsylvania Donora, Pennsylvania –– 19481948London, England London, England –– 19521952
These episodes provided the impetus for These episodes provided the impetus for regulations to reduce emissions, and regulations to reduce emissions, and associated air quality improvements.associated air quality improvements.
Historic Air Pollution EpisodesHistoric Air Pollution Episodes
In each case: In each case: a persistent (3 to 6 days) thermal inversiona persistent (3 to 6 days) thermal inversioncombined with significant industrial and, combined with significant industrial and, in the case of London, domestic pollutant in the case of London, domestic pollutant emissions emissions resulted in high groundresulted in high ground--level concentrations that level concentrations that caused acute illness and, in some cases, death in caused acute illness and, in some cases, death in the exposed populations.the exposed populations.
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Historic Air Pollution EpisodesHistoric Air Pollution Episodes
Meuse Valley, Belgium, December 1Meuse Valley, Belgium, December 1--5, 19305, 1930
Meuse Valley on a Clear DayMeuse Valley on a Clear Day
••Narrow river valleyNarrow river valley
••Temperature inversion to 90 mTemperature inversion to 90 m
••Elderly and those with heart and Elderly and those with heart and lung disease most affectedlung disease most affected
••63 deaths on Dec. 463 deaths on Dec. 4--55
••Specific pollutants were not Specific pollutants were not identifiedidentified
Historic Air Pollution EpisodesHistoric Air Pollution EpisodesDonora, Pennsylvania, October 25Donora, Pennsylvania, October 25--31, 194831, 1948
•• Temperature inversionTemperature inversion
•• Narrow river valleyNarrow river valley
•• 20 deaths on Oct. 3020 deaths on Oct. 30
•• Specific pollutants wereSpecific pollutants werenot identifiednot identified Donora, 1948Donora, 1948
October 29th, 12:00 noonOctober 29th, 12:00 noon
Historic Air Pollution EpisodesHistoric Air Pollution EpisodesLondon, England, December 5London, England, December 5--9, 19529, 1952
•• Temperature Inversion to 90mTemperature Inversion to 90m
•• Approximately 4,000 deathsApproximately 4,000 deaths
•• Pollutants measured at 12 locationsPollutants measured at 12 locations
•• Ambient particulates measured toAmbient particulates measured tobe 5 times higher than normalbe 5 times higher than normal
Police officer escorting a busPolice officer escorting a busthrough through ““smogsmog”” at 10:30 amat 10:30 am..
London, 1952London, 1952
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Average Weekly Number of Deaths, London England, Average Weekly Number of Deaths, London England, NovemberNovember--December, 1951 and 1952December, 1951 and 1952
0500
100015002000250030003500400045005000
12/6-12/13 12/14-12/21 12/22-12/290
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0500
100015002000250030003500400045005000
12/6-12/13 12/14-12/21 12/22-12/290
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4SOSO22, PPM, PPM SOSO22, PPM, PPMDeathsDeaths DeathsDeaths
1952195219511951
SOSO22SOSO22
Clean Air ActCriteria Air Pollutants
Particulate MatterCarbon MonoxideSulfur DioxideOzoneNitrogen OxidesLead
Hazardous Air Pollutants
Volatile Organic Compounds (VOCs)MetalsAldehydesSemivolatile Organic Compounds (SVOCs)Diesel Exhaust
188 total
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Particulate Matter
Associated with increased hospital admissions and emergency room visits for people with heart and lung disease.
aggravates asthma increases in respiratory symptoms like coughing and difficult orpainful breathing chronic bronchitis decreased lung function premature death
Settles on soil and water and harms the environment by changing the nutrient and chemical balance. Causes erosion and staining of structures
Why Particulates Matter?Why Particulates Matter?% change per% change per
10 ug/m10 ug/m33 increase in PM10increase in PM10Increase in Daily MortalityIncrease in Daily MortalityTotal deaths 1.0 %Respiratory Deaths 3.4 %Cardiovascular deaths 1.4 %
Increases in Respiratory Symptom ReportsIncreases in Respiratory Symptom ReportsLower respiratory 3.0 %Upper respiratory 0.7 %Cough 1.2 %
Source: (Dockery and Pope, 1994)Source: (Dockery and Pope, 1994)
Particulate Matter
Direct Formation Indirect Formation
Carbon Monoxide
Is poisonous even to healthy people at high levels in the air. Can affect people with heart disease. Can affect the central nervous system.
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Woodsmoke-Exposures and composition-Related health effects
http://farm3.static.flickr.com/2217/1702574218_076410df2a.jpg
http://www.stormcenter.com/media/envirocast/archive/071023/image4.jpg
Woodsmoke exposures and health effects : community exposures
Photo credit: http://www.sandiego.gov/newsflash
http://farm3.static.flickr.com/2217/1702574218_076410df2a.jpg
Individuals overlooking Tujunga, CA during the Station Fire, Southern California, Aug 26 to October 19, 2009Courtesy LA Times: http://www.latimes.com/news/local/la-0826-morris-fire-pictures
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http://www.pe.com/imagesdaily/2008/04-02/esperanza28gvo_400.jpg
Woodsmoke exposures and health effects: firefighter exposures
A fire-fighter at work during the Station Fire, Southern CaliforniaCourtesy LA Times: http://www.latimes.com/news/local/la-0826-morris-fire-pictures
Satellite image of the Station Fire, Southern California)Courtesy LA Times:http://www.latimes.com/news/local/la-0826-morris-fire-pictures
Dispersal of smoke and smog from the 1997 Southeast forest fires of IndonesiaCourtesy NASA: http://visibleearth.nasa.gov/view_rec.php?id=1651
Woodsmoke exposures and health effects : developing World
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Woodsmoke exposures and health effects:developed world
Woodsmoke
Components of woodsmoke similar to cigarette smoke1:
Polycyclic aromatic hydrocarbonsBenzenesAldehydesRespirable particulate matterCarbon monoxideetc…
1. Naeher, L. P., Brauer, M., Lipsett, M., Zelikoff, J. T., Simpson, C. D., Koenig, J. Q., and Smith, K. R. "Woodsmoke health effects: a review," Inhal Toxicol 19 (2007
Sensitive subpopulationsWomen and children in developing nations
Spend more time at home/in kitchen1
ChildrenElderlyImmunocompromised
1. Smith, K. R. "Deadly Household Pollution: A Call to Action," Indoor Air 16 (2006): 2.
2. Rehfuess, E., Mehta, S., and Prüss-Üstün, A. "Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals," Environmental Health Perspectives114 (2006): 373-378.
Health Effects of Woodsmoke Exposure
The following have been associated to woodsmoke exposure with varying degrees of certainty:
Increases in emergency room and physician visits due to respiratory diseases during wildfire eventsOxidative stress, pulmonary and systemic inflammationLung function declinesAcute respiratory infectionsCataractsAsthma exacerbationChronic obstructive pulmonary disease Low birth weight Nasopharyngeal and laryngeal cancers Tuberculosis
PM2.5 and CO often used as indicators of overall woodsmokeexposure
Naeher et al., 2007, Zelikoff et al., 2002, Ezzati et al., 2005
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Introduction
More than half the world’s population - 3.2 billion people – still relies on coal and biomass fuels such as wood, dung and crop residues to meet their basic cooking and energy needs1
90% of people residing in rural areas of developing countries2
Indoor air pollution from solid fuel use is among the world’s top ten causes of mortality and morbidity3
~2.5 million deaths each year in developing countries, representing 4-5% of the total global deaths that occur annually4
1. Rehfuess, E., et al. "Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals," Environmental Health Perspectives 114 (2006)2. Bruce, N., et al. "Indoor air pollution in developing countries: a major environmental and public health challenge," Bulletin Of The World Health Organization 78 (2000)3. Rehfuess, E., et al. "Indoor air pollution: 4000 deaths a day must no longer be ignored," Bulletin Of The World Health Organization 84 (2006) 4. Bruce, N., et al. "Health Effects of Indoor Air Pollution Exposure in Developing Countries," WHO, 2002
PM2.5
Particulate matter with aerodynamic diameter less than 2.5 micrometers
Penetrate deep into the lungs and may reach the alveolar region, potentially interfering with gas
exchange
Overall
The effects of exposure to indoor woodsmoke are many and variedPM2.5 and CO operate as a representation of overall exposure, as well as being independently damaging to human health
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Examples of woodsmoke-related
researchUS forest fire fighters
Developing world cookstoves
Methods: Study Site Savannah River Site, South Carolina
-198,000 acre National Environmental Research Park in S Carolina-15,000 to 18,000 acres burned annually
© Copyright 2002 The Tennesseanhttp://earthfromspace.photoglobe.info/img/map_savannah_river.jpg
PM2.5SKC pump at 4 L/min and teflon filter with BGI triplex cyclone
CO Draeger CO chemical sensor with datalogger
Self-administered QuestionnairePersonal estimation of woodsmoke exposure, burn size, symptoms etc.
Self-administered Time-Activity DiaryType of task by time and duration
240 person-day samples collected during winters 2003-05
203 during burn activities 37 during non-burn activities (36 on non-burn days)
Methods: Exposure Assessment
Work-shift PM2.5 exposureAverage on burn days (n = 180) – 316 µg/m3
(95% CL = 198, 515 µg/m3)Range – 5.9 to 2673 µg/m3
Average on non burn days (n = 35) – 16 µg/m3
(95% CL = 10, 25 µg/m3)
Results: PM2.5 exposure
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Results: CO exposure (n=149)
Work-shiftMean – 1.65 ppmRange – 0 to 14 ppm
Fire-lineMean – 3.09 ppmRange – 0 to 18 ppm
1-sec Peak Exposure470 ppmMean – 70 ppm
Real Time CO Concentrations
Time of Day (hh:mm:ss) 06:00:00 10:00:00 14:00:00 18:00:00
CO
Con
cent
ratio
n (p
pm)
0
50
100
150
200
250
300
350In Office--Fire Prep At Fire Line
Shift Average Conc. = 9.6 ppmMax Concentration = 305 ppmShift Length = 14.1 hrCOHb @ end of shift = 2.7%
Real Time CO Concentrations
Time of Day (hh:mm:ss) 06:00:00 10:00:00 14:00:00 18:00:00
CO
Con
cent
ratio
n (p
pm)
0
50
100
150
200
250
300
350
At Fire LineIn Office-Fire Prep
Shift Average Conc. = 2.0 ppmMax Concentration = 87 ppmShift Length = 12.2 hrCOHb @ end of shift = 0.6%
Geometric Mean Estimates of PM2.5 at Self-Estimated Exposure Levels
n=16
n=49
n=86
n=22
n=350
200
400
600
800
1000
1200
1400
0 1 2 3 4
Estimated Exposure
PM2.
5 C
once
ntra
tion
(ug/
m3)
with
95%
CL
0= non burn days1 = none to very little2 = low3 = moderate4 = high to very high
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0
500
1000
1500
2000
2500
3000
3500
0 2 4 6 8 10 12 14 16
CO (ppm)
PM2.
5(u
g/m
3)
Spearman correlation coefficient: 0.81 119 CO/PM2.5 pairsp < 0.01
Association between PM2.5 and CO
Results in Context
Indication that exposure exceeds American Council of Government Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for respirable particles – 3 mg/m3
Older studies observed exposures exceeding Occupational Safety and Health Administration (OSHA) Permissible Exposure Limit (PEL) – 5 mg/m3
Low CO exposureOSHA PEL (50 ppm) and ACGIH TLV (25 ppm) not exceeded1-sec peak exposure exceeded 200 ppm, ceiling limit, in 6 of 149 samples
Use of CO/PM2.5 correlation
Use of firefighter qualitative estimation
On-going Work – 2008-09
ExposurePM2.5
COLevoglucosan
Biomarker of ExposureOH-PAH
Biomarkers of Oxidative Stress8-OHdGMDA
Conclusion
Important exposure globallyPossible elevated occupational exposure among wildland firefightersExposure not adequately characterized
Also, limited health effect studies Results from such studies are essential for setting occupational exposure limits –USFS
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Testing the effectiveness of two cookstove intervention projects in the Santiago de Chuco Province of Peru
Introduction
An estimated 40% of the world’s population - 3.2 billion people – still relies on coal and biomass fuels such as wood, dung and crop residues to meet their basic cooking and energy needs1
90% of people residing in rural areas of developing countries2
Indoor air pollution from solid fuel use is among the world’s top ten causes of mortality and morbidity3
~2.5 million deaths each year in developing countries, representing 4-5% of the total global deaths that occur annually4
1. Rehfuess, E., et al. "Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals," Environmental Health Perspectives 114 (2006)2. Bruce, N., et al. "Indoor air pollution in developing countries: a major environmental and public health challenge," Bulletin Of The World Health Organization 78 (2000)3. Rehfuess, E., et al. "Indoor air pollution: 4000 deaths a day must no longer be ignored," Bulletin Of The World Health Organization 84 (2006) 4. Bruce, N., et al. "Health Effects of Indoor Air Pollution Exposure in Developing Countries," WHO, 2002
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Improved stoves
Most cost-effective solution1
When adequately designed, installed and maintained, effectively reduce indoor air pollution by means of2:
Better combustion Improvements in ventilation (e.g. through construction of a chimney) Lower emission levelsPotentially shorter cooking times
1. Mehta, S., et al. "The health benefits of interventions to reduce indoor air pollution from solid fuel use: a cost-effectiveness analysis," Energy for Sustainable Development VIII (2004)
2. WHO. "Interventions to reduce indoor air pollution," Indoor Air Pollution, 2009
Relevant Research
Potential benefits from the introduction of improved stoves include1,2,3,4
Less smokeLess wood useReduced coughLower blood pressureLess eye irritationFewer headachesLess lower-back pain
1. Masera, O., et al. 2007. “Impact of Patsari improved cookstoves on indoor air quality in Michoacan, Mexico”, Energy for Sustainable Development, XI(2) pp. 45-56 2. Smith-Sivertsen, T. et al. (2004). “Eye Discomfort, Headache And Back Pain Among Women In Guatemala Using Open Fires For Cooking And Heating.” Epidemiology 15(4).3. McCracken J, et al. Chimney stove intervention to reduce long-term woodsmoke exposure lowers blood pressure among Guatemalan women. Environ Health Perspect. 2007; 155:996-1001.4. Bailis, R., et al. 2007. “Performance testing for monitoring improved biomass stove interventions: experiences of the Household Energy and Health Project”, Energy for Sustainable Development, XI(2)
Study Objectives
Using PM2.5 and CO as air quality indicators, determine the efficiency of two improved stove models at reducing in-home exposures to harmful pollutantsMeasure biomarkers of health both before and after stove replacement to examine health benefitsAdd to the overall discussion in the literature about the effectiveness of such improved stove projects
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Methods
Chaguin/Cachulla Baja
Huayatan
Inside the homes Stove 1
Distributed in HuayatanProvided by Juntos National ProgramMaterials given to women to construct stoves themselves
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Stove 2
Distributed in Chaguin/Cachulla BajaProvided by BarrickOne man hired to build all stoves for the women
Study design – exposure assessment
64 Homes32 in Huayatan (stove 1)
All field and lab work done by our team
32 in Chaguin/Cachulla Baja (stove 2)Field work done by a separate team
Pre- and post-intervention samplingPersonal, kitchen, and fixed site
48 hoursPM2.5 (real-time and gravimetric) and CO (real-time)
Study design – health indicators
Pre- and post-intervention samplingAt the end of each 48-hour sampling period, measurements taken of:
Exhaled COExhaled NO (stove 1 only)Total Hb%COHbPb concentration
Adam
Pre-study preparations
Dry run
Town hall meeting
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An average 2-day sample
Specific days and times were given to each womanA maximum of 16 women could be sampled per week
All equipment prepped the night beforeEarly in the morning, field study trucks leave SantiagoArrive at woman’s home:
Set up stationary sampling site in kitchenSuit her up in personal sampling vestShe fills out questionnaire and receives time activity diary
48-hours later, equipment is gathered, health indicators are measured and urine is collected
Kitchen PM2.5DUSTTRAK™ Aerosol Monitor (realtime)SKC AirChek® 2000 Pump with Cyclone (gravimetric)
Personal PM2.5SKC AirChek® XR5000 Pump with Cyclone
CODrӓger Pac III
Air Sampling
Biomarker Sampling
Exhaled CO and %COHbBedfont Scientific Pico+Measures effects of smoke exposure
Exhaled NOAerocrine Inc. NIOX MinoPulmonary inflammation, immune system function
Total HemoglobinNIR Diagnostics HemoNIR co-oximeterOxygen transport efficiency
Blood LeadPossibly released in woodsmokeDevelopmental effects
Results
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Before After
Stove 1(home 30)
BeforeAfter
Stove 2
4848
Results
After three weeks of using the new stoves, reductions in indoor air pollution were seen across the board in all study communities, with:
Larger reduction in Kitchen vs. PersonalConsistent with other studies
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Real-time
The real-time data allows for a closer look at what is happening in each individual homeThe patterns of pollution are consistent (generally lining up with mealtimes)
Kitchen Exposure to PM2.5
05
101520253035404550
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
Time
mg/
m3
Pre-Intervention
Personal Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
pp
m
Kitchen Exposure to PM2.5
05
101520253035404550
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
Time
mg/
m3
Pre-Intervention
Personal Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
pp
m
Home 14 – Stove 1
Kitchen Exposure to PM2.5
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PMTime
mg/
m3
Post-Intervention
Personal Exposure to CO
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to PM2.5
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PMTime
mg/
m3
Post-Intervention
Personal Exposure to CO
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Home 14 – Stove 1
Kitchen Exposure to PM2.5
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PMTime
mg/
m3
Pre-Intervention Post-Intervention
Personal Exposure to CO
0
10
2 0
3 0
4 0
50
6 0
70
8 0
9 0
10 0
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to PM2.5
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PMTime
mg/
m3
Pre-Intervention Post-Intervention
Personal Exposure to CO
0
10
2 0
3 0
4 0
50
6 0
70
8 0
9 0
10 0
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Kitchen Exposure to CO
0102030405060708090
100
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM
ppm
Home 14 – Stove 1
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Personal Exposure to CO - Home 33
0
20
40
60
80
100
120
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
Time
CO
(pp
m)
Pre
Personal Exposure to CO - Home 33
0
20
40
60
80
100
120
4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM
Time
CO
(pp
m)
Post
Real-time Personal Exposure to CO Before and After the Installation of Stove Model 1 – Home 33 Subject Changes in ExCO, Stove 1
n=30
0
2
4
6
8
10
12
14
16
Pre Post
Exha
led
CO
(ppm
)
Exhaled NO vs Personal Exposure PM2.5
R = -0.340
1
2
3
4
5
2.5 3.5 4.5 5.5 6.5
Log Personal Exposure PM2.5
Log
Exha
led
NO
Pre (n=17)Post (n=23)
Exhaled NO vs Personal Exposure CO
R = -0.240
1
2
3
4
5
-5 -3 -1 1
Log Personal Exposure CO
Log
Exha
led
NO
Pre (n=16)Post (n=25)
Mount Auburn HospitalWilliam S Beckett
UGAAdam GrayFemi AdetonaAdwoa AgyepongGideon St. HelenAnna Hejl
UW SeattleChris Simpson
UC IrvineRufus EdwardsMichael Johnson
USFSSRS Firefighter crewJohn BlakeStephen LenzoDan SheaMark FrizzellPaul LinseJeff PreveyDave WilsonEd Olsen
Acknowledgments and collaborators
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Acknowledgments
Special thanks to:The Barrick Gold CorporationIng. Jose Murgia Zanier, and the Gobierno Regional de La LibertadThe local government of Santiago de ChucoThe Research Team, for being awesome
Manuel Aguilar Villalobos: Team
Leader
Tonia Villalobos: Field Assistant
Adam Eppler: Researcher and
Translator
Jessica Fitzgerald: Field Technician
Stephen Dorner: Translator and Field
Technician
Luke P. Naeher: Principle Investigator
Kevin Horton: Researcher
Adam Gray: Lead Research
Technician
Daniel Pope: Field Technician
Elizabeth Irvin: Field Technician
Thank youQuestions?