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A review of setup error in supine breast radiotherapy using cone-beam computed tomography

Setup error in breast radiotherapy (RT) measured with 3-dimensional cone-beam computed tomography (CBCT) is becoming more common. The purpose of this study is to review the literature relating to the magnitude of setup error in breast RT measured with CBCT. The different methods of image registration between CBCT and planning computed tomography (CT) scan were also explored. A literature search, not limited by date, was conducted using Medline and Google Scholar with the following key words: breast cancer, RT, setup error, and CBCT. This review includes studies that reported on systematic and random errors, and the methods used when registering CBCT scans with planning CT scan. A total of 11 relevant studies were identified for inclusion in this review. The average magnitude of error is generally less than 5 mm across a number of studies reviewed. The common registration methods used when registering CBCT scans with planning CT scan are based on bony anatomy, soft tissue, and surgical clips. No clear relationships between the setup errors detected and methods of registration were observed from this review. Further studies are needed to assess the benefit of CBCT over electronic portal image, as CBCT remains unproven to be of wide benefit in breast RT.

61 RADIATION PROTECTION AND DOSIMETRY↗

Pyrolysis technologies for municipal solid waste: A review

Highlights: • MSW pyrolysis reactors, products and environmental impacts are reviewed. • MSW pyrolysis still has to deal with flue gas emissions and products’ contamination. • Definition of standardized products is suggested to formalize MSW pyrolysis technology. • Syngas is recommended to be the target product for single MSW pyrolysis technology. - Abstract: Pyrolysis has been examined as an attractive alternative to incineration for municipal solid waste (MSW) disposal that allows energy and resource recovery; however, it has seldom been applied independently with the output of pyrolysis products as end products. This review addresses the state-of-the-art of MSW pyrolysis in regards to its technologies and reactors, products and environmental impacts. In this review, first, the influence of important operating parameters such as final temperature, heating rate (HR) and residence time in the reaction zone on the pyrolysis behaviours and products is reviewed; then the pyrolysis technologies and reactors adopted in literatures and scale-up plants are evaluated. Third, the yields and main properties of the pyrolytic products from individual MSW components, refuse-derived fuel (RDF) made from MSW, and MSW are summarised. In the fourth section, in addition to emissions from pyrolysis processes, such as HCl, SO{sub 2} and NH{sub 3}, contaminants in the products, including PCDD/F and heavy metals, are also reviewed, and available measures for improving the environmental impacts of pyrolysis are surveyed. It can be concluded that the single pyrolysis process is an effective waste-to-energy convertor but is not a guaranteed clean solution for MSW disposal. Based on this information, the prospects of applying pyrolysis technologies to dealing with MSW are evaluated and suggested.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Reprint of: Pyrolysis technologies for municipal solid waste: A review

Highlights: • MSW pyrolysis reactors, products and environmental impacts are reviewed. • MSW pyrolysis still has to deal with flue gas emissions and products’ contamination. • Definition of standardized products is suggested to formalize MSW pyrolysis technology. • Syngas is recommended to be the target product for single MSW pyrolysis technology. - Abstract: Pyrolysis has been examined as an attractive alternative to incineration for municipal solid waste (MSW) disposal that allows energy and resource recovery; however, it has seldom been applied independently with the output of pyrolysis products as end products. This review addresses the state-of-the-art of MSW pyrolysis in regards to its technologies and reactors, products and environmental impacts. In this review, first, the influence of important operating parameters such as final temperature, heating rate (HR) and residence time in the reaction zone on the pyrolysis behaviours and products is reviewed; then the pyrolysis technologies and reactors adopted in literatures and scale-up plants are evaluated. Third, the yields and main properties of the pyrolytic products from individual MSW components, refuse-derived fuel (RDF) made from MSW, and MSW are summarised. In the fourth section, in addition to emissions from pyrolysis processes, such as HCl, SO{sub 2} and NH{sub 3}, contaminants in the products, including PCDD/F and heavy metals, are also reviewed, and available measures for improving the environmental impacts of pyrolysis are surveyed. It can be concluded that the single pyrolysis process is an effective waste-to-energy convertor but is not a guaranteed clean solution for MSW disposal. Based on this information, the prospects of applying pyrolysis technologies to dealing with MSW are evaluated and suggested.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

2015 Peer Review Report

In the spring and summer of 2015, the Bioenergy Technologies Office (BETO or the Office) of the U.S. Department of Energy (DOE) implemented an external peer review of the projects in its research, development and demonstration (RD&D) portfolio. The Office manages a diverse portfolio of technologies across the spectrum of applied RD&D within the dynamic context of changing budgets and Administration priorities. The Office portfolio is organized according to the biomass-to-bioenergy supply chain—from the feedstock source to the end user (see Figure 1)—with major focus on feedstock supply and biomass conversion. The 2015 Project Peer Review took place March 23-27, 2015, outside of Washington, D.C., in Alexandria, Virginia, and evaluated most of the publicly funded projects in BETO’s portfolio. The subsequent Program Management Review took place on June 25, 2015, in Washington, D.C., and provided an Office- level assessment of strategic planning and programmatic initiatives. The peer review process enables external stakeholders to provide feedback on the responsible use of taxpayer funding and develop recommendations for the most efficient and effective ways to accelerate the development of an advanced bioenergy industry. The planning and execution of these reviews was completed over the course of 10 months, and this report includes the results of both events.

09 BIOMASS FUELS↗

2017 Water Power Project Peer Review Summary Report - Volume 1

The Water Power Technologies Office Peer Review Report summarizes the findings from a 2017 peer review held in Arlington, Virginia, with nearly 300 representatives from our national laboratories, industry, academic institutions, and other stakeholder organizations. Volume I includes sections 1–5 of the report: the executive summary, synopses of the program- and project-level evaluation results, and WPTO’s response to the 2017 Peer Review findings. This report details the results of the Water Power Peer Review Meeting, which was held in February 2017 in Arlington, VA. The purpose of the review was to evaluate WPTO-funded projects for their contribution to the mission and goals of the WPTO and DOE, assess progress against stated objectives, and appraise WPTO’s overall management and performance.

13 HYDRO ENERGY↗

The Journal of Open Source Software (JOSS): Bringing Open-Source Software Practices to the Scholarly Publishing Community for Authors, Reviewers, Editors, and Publishers

Open-source software (OSS) is a critical component of open science, but contributions to the OSS ecosystem are systematically undervalued in the current academic system. The Journal of Open Source Software (JOSS) contributes to addressing this by providing a venue (that is itself free, diamond open access, and all open-source, built in a layered structure using widely available elements/services of the scholarly publishing ecosystem) for publishing OSS, run in the style of OSS itself. A particularly distinctive element of JOSS is that it uses open peer review in a collaborative, iterative format, unlike most publishers. Additionally, all the components of the process—from the reviews to the papers to the software that is the subject of the papers to the software that the journal runs—are open. We describe JOSS’s history and its peer review process using an editorial bot, and we present statistics gathered from JOSS’s public review history on GitHub showing an increasing number of peer reviewed papers each year. We discuss the new JOSSCast and use it as a data source to understand reasons why interviewed authors decided to publish in JOSS. JOSS’s process differs significantly from traditional journals, which has impeded JOSS’s inclusion in indexing services such as Web of Science. In turn, this discourages researchers within certain academic systems, such as Italy’s, which emphasize the importance of Web of Science and/or Scopus indexing for grant applications and promotions. JOSS is a fully diamond open-access journal with a cost of around US$\$$5 per paper for the 401 papers published in 2023. The scalability of running JOSS with volunteers and financing JOSS with grants and donations is discussed.

96 KNOWLEDGE MANAGEMENT AND PRESERVATION↗

Review: mechanical behavior of metal/ceramic interfaces in nanolayered composites—experiments and modeling

In this study, recent experimental and modeling studies in nanolayered metal/ceramic composites are reviewed, with focus on the mechanical behaviors of metal/nitrides interfaces. The experimental and modeling studies of the slip systems in bulk TiN are reviewed first. Then, the experimental studies of interfaces, including co-deformation mechanism by micropillar compression tests, in situ TEM straining tests for the dynamic process of the co-deformation, thickness-dependent fracture behavior, and interrelationship among the interfacial bonding, microstructure, and mechanical response, are reviewed for the specific material systems of Al/TiN and Cu/TiN multilayers at nanoscale. The modeling studies reviewed cover first-principles density functional theory-based modeling, atomistic molecular dynamics simulations, and mesoscale modeling of nanolayered composites using discrete dislocation dynamics. The phase transformation between zinc-blende and wurtzite AlN phases in Al/AlN multilayers at nanoscale is also reviewed. Finally, a summary and perspective of possible research directions and challenges are given.

36 MATERIALS SCIENCE↗

A Thermodynamic Model for ZrO 2 (am) Solubility at 25 °C in the Ca 2+ –Na + –H + –Cl - –OH - –H 2 O System: A Critical Review

Zirconium is an important element in the nuclear fuel cycle. Thermodynamic data and models to reliably predict Zr-OH system behavior in various conditions including high ionic strengths are required and currently are unavailable. Most available experimental data are rather old, obtained using inadequate methodologies, and provide equilibrium constant values that differ by many orders of magnitude. Previous reviews have recommended values based on available data. These reviews used all of the available data, including poor quality data, in a global fit to determine these values. This has resulted in recommended thermodynamic models with a large number of polynuclear species and a number of mononuclear species with values of thermodynamic constants for the solubility product of ZrO 2 (am) and Zr-OH hydrolysis constants that are many orders of magnitude different than those for the reliable analogous Hf reactions. In this critical review, we have evaluated the quality of the available data, selected only those data that are of high quality, and reinterpreted all of the high quality data using SIT and Pitzer models for applications to high ionic strength solutions. Herein for 25°C we 1) present formation constant values for ZrOH 3+ , Zr(OH) 2+ 2 , Zr(OH) 4 (aq), Zr(OH) 5 - , and Zr(OH) 6 2- , and the solubility product for ZrO 2 (am) which are consistent with the Hf system, 2) report a revised value for the formation of Ca 3 Zr(OH) 6 4+ , 3) show that several hypothetical polynuclear species (Zr 3 (OH) 9 3+ , Zr 4 (OH) 15 + , and Zr 4 (OH) 16 (aq)) proposed in previous reviews are not needed, and 4) show that polynuclear species (Zr 3 (OH) 4 8+ and Zr 4 (OH) 8 8+ ) are not important in a very extensive H + concentration range (0.1 to 10 -15.4 mol·kg -1 ). Our review has also resulted in SIT and Pitzer ion-interaction parameters applicable to as high ionic strength solutions as 5.6 mol·kg -1 in NaCl, 2.11 mol·kg -1 in CaCl 2 , and 23.5 mol·kg -1 in NaOH.

solubility, ZrO2(am), solubility product, thermody↗

High entropy alloys: A focused review of mechanical properties and deformation mechanisms

The high-entropy alloy (HEA) concept was based on the idea that high mixing entropy can promote formation of stable single-phase microstructures. During the past 15 years, various alloy systems have been explored to identify HEA systems with improved property combinations, leading to an extraordinary growth of this field. In the large pool of alloys with varying characteristics, the first single-phase HEA with good tensile properties, the equiatomic CrMnFeCoNi alloy has become the benchmark material, and it forms the basis of much of our current fundamental understanding of HEA mechanical behavior. As the field is evolving to the more broadly defined complex concentrated alloys (CCAs) and the available data in the literature increase exponentially, a fundamental question remains unchanged: how special are these new materials? In the first part of this review, select mechanical properties of HEAs and CCAs are compared with those of conventional engineering alloys. This task is difficult because of the limited tensile data available for HEAs and CCAs. Additionally, the wider suite of mechanical properties needed to assess structural materials is woefully lacking. Nonetheless, our evaluations have not revealed many HEAs or CCAs with properties far exceeding those of conventional engineering alloys, although specific alloys can show notable enhancements in specific properties. Consequently, it is reasonable to first approach the understanding of HEAs and CCAs through the assessment of how the well-established deformation mechanisms in conventional alloys operate or are modified in the presence of the high local complexity of the HEAs and CCAs. The second part of the paper provides a detailed review of the deformation mechanisms of HEAs with the FCC and BCC structures. For the former, we chose the CrMnFeCoNi (Cantor) alloy because it is the alloy on which the most rigorous and thorough investigations have been performed and, for the latter, we chose the TiZrHfNbTa (Senkov) alloy because this is one of the few refractory HEAs that exhibits any tensile ductility at room temperature. As expected, our review shows that the fundamental deformation mechanisms in these systems, and their dependence on basic physical properties, are broadly similar to those of conventional FCC and BCC metals. The third part of this review examines the theoretical and modeling efforts to date that seek to provide either qualitative or quantitative understanding of the mechanical performance of FCC and BCC HEAs. Since experiments reveal no fundamentally new mechanisms of deformation, this section starts with an overview of modeling perspectives and fundamental considerations. Next, the review turns to the evolution of modeling and predictions as compared to recent experiments, highlighting both successes and limitations. Finally, in spite of some significant successes, important directions for further theory development are discussed. Overall, while the individual deformation mechanisms or properties of the HEAs and CCAs are not, by and large, “special” relative to conventional alloys, the present HEA rush remains valuable because the compositional freedom that comes from the multi-element space will allow exploration of whether multiple mechanisms can operate sequentially or simultaneously, which may yet lead to the creation of new alloys with a spectrum of mechanical properties that are significantly superior to those of current engineering alloys.

36 MATERIALS SCIENCE↗

Building energy simulation coupled with CFD for indoor environment: A critical review and recent applications

This paper presents a comprehensive review of the open literature on motivations, methods and applications of linking stratified airflow simulation to building energy simulation (BES). First, we reviewed the motivations for coupling prediction models for building energy and indoor environment. This review classified various exchanged data in different applications as interface data and state data, and found that choosing different data sets may lead to varying performance of stability, convergence, and speed for the co-simulation. Second, our review shows that an external coupling scheme is substantially more popular in implementations of co-simulation than an internal coupling scheme. The external coupling is shown to be generally faster in computational speed, as well as easier to implement, maintain and expand than the internal coupling. Third, the external coupling can be carried out in different data synchronization schemes, including static coupling and dynamic coupling. In comparison, the static coupling that performs data exchange only once is computationally faster and more stable than the dynamic coupling. However, concerning accuracy, the dynamic coupling that requires multiple times of data exchange is more accurate than the static coupling. Furthermore, the review identified that the implementation of the external coupling can be achieved through customized interfaces, middleware, and standard interfaces. The customized interface is straightforward but may be limited to a specific coupling application. The middleware is versatile and user-friendly but usually limited in data synchronization schemes. The standard interface is versatile and promising, but may be difficult to implement. Current applications of the co-simulation are mainly energy performance evaluation and control studies. Finally, we discussed the limitations of the current research and provided an overview for future research.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Thermal treatment of solid residues from WtE units: A review

Highlights: • We review the thermal treatment methods for ashes and residues from WtE plants. • We review the results from extensive laboratory work on vitrification, melting and vaporization of ash. • We analyze the results from the extensive patent literature on thermal treatment. • We review industrial concepts for thermal treatment of ash. - Abstract: Thermal treatment methods of bottom ash, fly ash and various types of APC (air pollution control) residues from waste-to-energy plants can be used to obtain environmentally stable material. The thermal treatment processes are meant to reduce the leachability of harmful residue constituents, destroy toxic organic compounds, reduce residue volume, and produce material suitable for utilization. Fly ash and APC residues often have high levels of soluble salts, particularly chlorides, metals such as cadmium, lead, copper and zinc, and trace levels of organic pollutants such as dioxins and furans. Different thermal treatment methods can be used to either decompose or stabilize harmful elements and compounds in the ash, or separate them from the ash to get a material that can be safely stored or used as products or raw materials. In the present paper, thermal treatment methods, such as sintering, vitrification, and melting have been reviewed. In addition to a review of the scientific literature, a survey has been made of the extensive patent literature in the field.

54 ENVIRONMENTAL SCIENCES↗

Bioproducts from high-protein algal biomass: An economic and environmental sustainability review and risk analysis

This report has High-protein algal biomass as an important bio-commodity that has the potential to provide a new source of sustainable protein products. Herein is a critical review that identifies 1) the most relevant sustainability findings related to the processing of proteinaceous algal biomass to higher value protein products and 2) the potential pathways to improve life cycle assessment (LCA) and techno-economic analysis (TEA) metrics, including life-cycle carbon dioxide equivalent (CO 2 eq), life cycle energy, and minimum selling price (MSP) of these products. The critical review of the literature revealed a large variation in model input parameters relating to these metrics. Therefore, a Monte Carlo analysis was conducted to assess the risk associated with these input variations. To understand the uncertainties that propagate into high-protein algae to products’ systems, we reviewed more than 20 state-of-the-art unit operations for algal biomass processing., including cell disruption, protein solubilization, protein precipitation and purification, and protein concentration. We evaluated displacement of proteinaceous products by algal-bioproducts, including ruminant feed, aquaculture feed, protein tablets, and biopolymers and biopolyesters, with prices in the market ranging from 1.9 to 120 $\$$ kg -1 protein. This review realized that the MSP of ruminant and non-ruminant feed ranges from 0.65±0.56 to 2.9±1.1 $\$$ kg -1 protein, and bioplastics’ MSP ranges from 0.97 to 7.0 $\$$ kg -1 protein. Regarding LCA metrics, there is limited research on life cycle energy in proteinaceous biomass concentration and bioproduct systems, reported at 32.7 MJ kg protein -1 , for animal feed displacement. Animal feed emissions in the literature report negative fluxes, representing environmental benefits, as low as -3.7 kgCO 2 eq kg -1 protein and positive fluxes, i.e., global warming potential, as high as 12.8 kgCO 2 eq kg -1 protein. There is limited research on bioplastics life cycle emissions reported at 0.6 kgCO 2 eq kg -1 protein. In general, the studies to date of algae-derived protein bioproducts showed similar life cycle emissions to soybean meals, nylon, polymers, and polystyrenes. Our risk analysis realized that more than 50% of scenarios can result in negative-net life cycle CO 2 eq emissions. This review and risk analysis assess and demonstrate the scenarios that improve economic and environmental sustainability metrics in high-protein algal bioproducts systems.

09 BIOMASS FUELS↗

A systematic review of validated suicide outcome classification in observational studies

Abstract Background Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. Methods We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. Results We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2–19% sensitivity, and 83–100% positive predictive value (PPV). ICD algorithms that included events with ‘uncertain’ intent had 4–70% PPV. The three best-performing algorithms had 74–92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14–68% sensitivity and 0–56% PPV. Studies estimated 19–80% sensitivity for chart review, and 41–97% sensitivity and 100% PPV for vital records. Conclusions Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.

Swain, Richard S.↗

Timely deposition of macromolecular structures is necessary for peer review

Deposition of crystallographic structures should be concurrent with or prior to manuscript submission for peer review, enabling validation and increasing reliability of the PDB. Most of the macromolecular structures in the Protein Data Bank (PDB), which are used daily by thousands of educators and scientists alike, are determined by X-ray crystallography. It was examined whether the crystallographic models and data were deposited to the PDB at the same time as the publications that describe them were submitted for peer review. This condition is necessary to ensure pre-publication validation and the quality of the PDB public archive. It was found that a significant proportion of PDB entries were submitted to the PDB after peer review of the corresponding publication started, and many were only submitted after peer review had ended. It is argued that clear description of journal policies and effective policing is important for pre-publication validation, which is key in ensuring the quality of the PDB and of peer-reviewed literature.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗

Review of lattice results concerning low-energy particle physics

We review lattice results related to pion, kaon, D- and B-meson physics with the aim of making them easily accessible to the particle physics community. More specifically, we report on the determination of the light-quark masses, the form factor f+(0), arising in semileptonic K -> pi transition at zero momentum transfer, as well as the decay constant ratio fK/fpi of decay constants and its consequences for the CKM matrix elements Vus and Vud. Furthermore, we describe the results obtained on the lattice for some of the low-energy constants of SU(2)LxSU(2)R and SU(3)LxSU(3)R Chiral Perturbation Theory and review the determination of the BK parameter of neutral kaon mixing. The inclusion of heavy-quark quantities significantly expands the FLAG scope with respect to the previous review. Therefore, for this review, we focus on D- and B-meson decay constants, form factors, and mixing parameters, since these are most relevant for the determination of CKM matrix elements and the global CKM unitarity-triangle fit. In addition we review the status of lattice determinations of the strong coupling constant alpha_s.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗

Review of lattice results concerning low-energy particle physics: Flavour Lattice Averaging Group (FLAG)

We review lattice results related to pion, kaon, D- and B-meson physics with the aim of making them easily accessible to the particle-physics community. More specifically, we report on the determination of the light-quark masses, the form factor f + (0), arising in the semileptonic K → π transition at zero momentum transfer, as well as the decay constant ratio f K /f π and its consequences for the CKM matrix elements V us and V ud . Furthermore, we describe the results obtained on the lattice for some of the low-energy constants of SU(2) L × SU(2) R and SU(3) L × SU(3) R Chiral Perturbation Theory. We review the determination of the B K parameter of neutral kaon mixing as well as the additional four B parameters that arise in theories of physics beyond the Standard Model. The latter quantities are an addition compared to the previous review. For the heavy-quark sector, we provide results for m c and m b (also new compared to the previous review), as well as those for D- and B-meson-decay constants, form factors, and mixing parameters. These are the heavy-quark quantities most relevant for the determination of CKM matrix elements and the global CKM unitarity-triangle fit. Finally, we review the status of lattice determinations of the strong coupling constant α s .

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗

FLAG Review 2019: Flavour Lattice Averaging Group (FLAG)

Abstract We review lattice results related to pion, kaon, D -meson, B -meson, and nucleon physics with the aim of making them easily accessible to the nuclear and particle physics communities. More specifically, we report on the determination of the light-quark masses, the form factor $$f_+(0)$$ f + ( 0 ) arising in the semileptonic $$K \rightarrow \pi $$ K → π transition at zero momentum transfer, as well as the decay constant ratio $$f_K/f_\pi $$ f K / f π and its consequences for the CKM matrix elements $$V_{us}$$ V us and $$V_{ud}$$ V ud . Furthermore, we describe the results obtained on the lattice for some of the low-energy constants of $$SU(2)_L\times SU(2)_R$$ S U ( 2 ) L × S U ( 2 ) R and $$SU(3)_L\times SU(3)_R$$ S U ( 3 ) L × S U ( 3 ) R Chiral Perturbation Theory. We review the determination of the $$B_K$$ B K parameter of neutral kaon mixing as well as the additional four B parameters that arise in theories of physics beyond the Standard Model. For the heavy-quark sector, we provide results for $$m_c$$ m c and $$m_b$$ m b as well as those for D - and B -meson decay constants, form factors, and mixing parameters. These are the heavy-quark quantities most relevant for the determination of CKM matrix elements and the global CKM unitarity-triangle fit. We review the status of lattice determinations of the strong coupling constant $$\alpha _s$$ α s . Finally, in this review we have added a new section reviewing results for nucleon matrix elements of the axial, scalar and tensor bilinears, both isovector and flavor diagonal.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗

Indoor Environmental Exposures and Exacerbation of Asthma: An Update to the 2000 Review by the Institute of Medicine

Background: Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma. Objectives: In this review we provide an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma. Methods: Peer-reviewed articles published from 2000 to 2013 on indoor exposures and exacerbation of asthma were identified through PubMed, from reference lists, and from authors’ files. Articles that focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence. Results: Sixty-nine eligible articles were included. Major changed conclusions include a causal relationship with exacerbation for indoor dampness or dampness-related agents (in children); associations with exacerbation for dampness or dampness-related agents (in adults), endotoxin, and environmental tobacco smoke (in preschool children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, nitrogen dioxide, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents. Discussion: This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until all available evidence is examined more thoroughly. Conclusion: Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in nonsensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.

60 APPLIED LIFE SCIENCES↗