Indoor Air Cartoon Journal, April 2023, Volume 6, #141

[Cite as: Fadeyi MO (2023). Take the provision of ventilation and its rate seriously when diagnosing and prognosing sinusitis. Indoor Air Cartoon Journal, April 2023, Volume 6, #141.]

Fictional Case Story (Audio)

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A poor understanding of the difference between a symptom, problem, and cause of a problem could compromise how resources are made available and used to improve human health. The poor understanding has led to many situations where medical professionals have failed to consider the importance of recommending to their patients to adopt adequate ventilation practices to improve their health when diagnosing and prognosing health problems that exposure to indoor air pollutants can exacerbate. The poor appreciation of the role of adopting adequate ventilation rates to improve indoor air quality and health has led to situations in which medical professionals, patients, and patients’ relatives consume resources with little usefulness delivered to them. Little usefulness is provided because health problems and their symptoms which are susceptible to indoor air pollutants, keep reoccurring. The journey of a young man in helping to increase the appreciation of the importance of adopting ventilation to improve human health is the subject of this short fiction story.

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Ibrahim Cisse was a new Ph.D. student in the Department of Civil and Environmental Engineering (CEE) at the University of Rolland in a country called Eastland. Ibrahim had his first research paper accepted for publication and presentation at an international conference to be held in a country called Cantuval. Ibrahim wrote a short review paper, ‘The impact of ventilation and its rate on indoor air quality and human health: Evidence in the past 15 years.’

This was Ibrahim’s initial review effort at the start of his Ph.D. study. Ibrahim was eight months into his Ph.D. when he submitted the short review paper to the conference. Ibrahim was eager to attend the conference as he would have the opportunity to meet several top indoor air scientists he had been hearing about and reading their papers. He wanted to meet them with the hope of getting ideas that would help him finalise his Ph.D. research proposal to confirm the direction of his Ph.D. research study. The proposal was usually due 18 months after a student enrolled in a Ph.D. programme.

Typically, citizens of Eastland do not need a visa to enter Cantuval. However, Ibrahim and three of his fellow Ph.D. students in the department who were not from Eastland but from countries whose citizens needed a visa to enter Cantuval planned to travel together to attend the conference to present their respective papers. The other three Ph.D. students were from the same country, different from that of Ibrahim. The other three Ph.D. students came from a country regarded to be slightly below the World Bank’s high-income threshold. Ibrahim was a citizen of Nakum, a lower-middle-income country.

As Cantuval did not have an embassy in Eastland, the students decided to go to the Maneburg embassy in Eastland to apply for the required visa, called the Bazen visa. The Bazen visa would allow the students to move easily from Maneburg to Cantuval. Maneburg, Cantuval, and some other countries in the same continent had a visa agreement that would allow anyone with a Buzan visa to move freely. For context, Maneburg and Cantuval were high-income economy countries.

The students submitted their applications at the Maneburg embassy and were told by the embassy staff that they should return in three weeks. The four Ph.D. students returned to the embassy three weeks later as instructed. Ibrahim’s visa application was rejected while the visas of the other three Ph.D. students were granted, despite all four students submitting the same travelling documents, except their passports.

Ibrahim was surprised! Ibrahim approached the embassy staff in charge to find out why his visa application was rejected while his mates’ applications were approved. He asked not to question the decision but to know whether he missed any information needed for the visa application with the hope of reapplying with the required document. “You are from a dangerous country, and we are not sure you will come back if you are granted the visa,” the embassy staff said. Ibrahim Cisse was shocked!

Ibrahim could not believe what he had just heard from the embassy staff. He could not believe an embassy staff could say such a thing. “I am a Ph.D. student. Why would I not come back when I had so much at stake?” Ibrahim said after recovering from his shock. “Sorry! There is nothing I can do for you. That is our decision,” the embassy staff said. The Maneburg embassy staff further said, “Anyway, our country is not where your conference will be held. You can go to Sunbon, where the Cantuval embassy is.” The embassy staff said this in a way to dismiss Ibrahim. Subon is a country in the same region as Eastland.

Ibrahim was devastated! He told his Ph.D. supervisor what happened. The supervisor consoled him and told him not to worry as there would be many similar conferences to go to during his Ph.D. study. However, Ibrahim did not want to accept the defeat. He thought that the Bazen visa rejection stamp in his passport could work against him in the future if he did not get the visa this time.

Ibrahim decided to go to the Cantuval embassy in Sunbon to apply for the Bazen visa even though there was no guarantee that the visa would be granted, especially as the conference would start in 4 weeks. Ibrahim was the kind of person that liked to explore all possible options available to him to solve a problem.

Alas! Ibrahim needed a visa to enter Sunbon. He immediately applied for the visa. A week later, he got a visa to enter Sunbon. Ibrahim boarded a plane to Sunbon the next day. As his flight to Sunbon was about to land at Sunbon International Airport, there was a problem. The pilots could not land the plane as it was nighttime and raining heavily. The visibility was extremely poor, and the plane was not sophisticated. The pilot attempted to land three times but could not. When the pilot decided to land the fourth time, the plane skidded off the runway and headed towards the wooded forest.

The plane exploded. A big bang with huge fire and tick smoke covered the sky. One hundred and fifty-three people were on the plane, and only six survived at the accident site. One hundred forty-seven people died immediately. The six people that survived were badly hurt. Ibrahim was one of the six people who survived but was unconscious and bleeding a lot when he was taken out of the burning plane.

The unconscious Ibrahim could have been left in the plane if not for the person beside him, who survived the crash and was conscious when the rescuer came. The conscious survivor beside Ibrahim told the rescuers that Ibrahim was still breathing. Ibrahim was rushed to the hospital unconscious.

Ibrahim’s supervisor, Professor Arun Kim, knew Ibrahim was travelling to Sunbon but was not sure of the particular plane he had boarded. Prof. Kim was concerned when he had a plane heading to Sunbon crash. He made several attempts to contact Ibrahim but to no avail. Prof. Kim only got to know that Ibrahim was on the ill-fated plane when Ibrahim’s roommate informed the department that he was on the plane that crashed.

A representative from the CEE department called Ibrahim’s parents, who were in his home country, Nakum. Ibrahim’s father travelled to Sunbon to be beside his son. Prof. Kim also travelled to Sunbon to check on Ibrahim in the hospital where he was hospitalised. Ibrahim was in a coma for four months before he ……   

Ibrahim suffered a severe blow to his head from the plane crash. The injury and the subsequent brain surgery he had caused his brain to “rewire” itself, thereby creating a new neural pathway that enabled Ibrahim to see and understand things in a completely new and sophisticated way. Interestingly, Ibrahim’s cognitive ability improved significantly, with little or no psychological side effects. Ibrahim could process the information he was exposed to generate processed information (experience, i.e., knowledge and understanding) within seconds and had tremendous memory capability that was rare in humans.

While in a coma, he had a vision of being a professor at a university and working in a country where the culture of problem-solving was very poor. At that time, the inadequacies in problem-solving had compromised the country’s social, economic, and environmental well-being. The inability to solve problems effectively was primarily rooted in the inability to differentiate between a symptom, a problem, and the root cause(s) of the problem. Ibrahim observed that the inability to distinguish between these three terms often led to poor diagnoses of problems and their prognoses. The deficiency in the problem-solving culture found its way into how students attempted to solve problems in the institutes of higher learning and how they were taught.  

The need to contribute to the change in this poor culture led him to create a research and education lab called Healthy Buildings Problem-Solving Lab (HBP Lab). One of the research projects conducted in his lab was the impact of ventilation rate on sinusitis. He hypothesised with his research team that the risk of sinusitis occurrence would be reduced with an appropriate increase in ventilation rate.

To understand the role of ventilation and how it can be used for healthy living practices, Prof. Ibrahim thought it was important to understand symptoms, the problem, and the causes of the problem in the context of his research. He believed that before differentiating between these three terms, it is important to figure out the goal to be achieved and the reason for the need to achieve the goal. The following are the thoughts Ibrahim shared with his students.

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Ibrahim thought that in this context, the goal is for the human body to have features or characteristics that will provide the functions and performance needed for achieving healthy wellbeing. He thought the reason for striving to achieve the goal is to be of value to oneself and society. Sinusitis, also known as a sinus infection, is the inflammation of the tissues lining the sinuses. Sinus means air-filled cavities filled with mucous membranes. Of interest to Ibrahim were the sinuses at the face, i.e., cheekbones, forehead, and nose.

A compromise to a sinus’s features or characteristics will compromise the sinus’s expected function or performance, thereby compromising the healthy wellbeing, and the compromise manifested in the form of symptoms. The value delivery of a person suffering from sinusitis symptoms will reduce when tasked to solve a problem at workplaces, learning environments, or personal settings. A lower value delivery means more resources, e.g., time, invested in solving a problem with little or no usefulness delivered. Sometimes, the amount of resources invested will be so little that no meaningful usefulness can be delivered from it.

Sinusitis symptoms include nasal congestion or stuffiness, thick yellow or nasal discharge, sore throat, cough, high temperature, headache, etc. This evidence is otherwise known as symptoms. So, what is a symptom? Ibrahim reasoned that a symptom is an observable or measurable indication or manifestation that there could be a problem. What is a problem? Ibrahim reasoned once again. A problem is a gap between the current performance or functions and the required or expected performance due to a system or solution’s current features or characteristics being lower than expected or required.

It is important to note that when discussing the gap, it must be addressed in the context of a system (solution) to say it is a problem, not a symptom. For example, a gap in temperature level is a symptom, not a problem. Temperature is not a system (solution) with a feature or characteristics generating a performance or function. A system (solution) is meant to consume an input and generate an output of usefulness.

“We say there is something wrong with a system (solution) provided or available when it unnecessarily consumes input (resources) to generate output that is either useful or not, or the consuming little or no resources and missed the opportunity to provide the required or expected usefulness.” Ibrahim reasoned. ‘Something wrong with a system (solution)’ means the current features or characteristics of a system (solution) are lower than required or expected, thereby generating lower performance or functions—the definition of a problem. A system (solution) could be physiological (or physical), psychological, economic, and/or social. 

Technically, a system (solution) will continue to have the expected or required features or characteristics and give the performance or functions level it is designed, created, or expected to give, assuming it was done properly, if nothing changes the structure or composition of the system. A change in the structure or composition of a system will result in a change in the feature or characteristics of the system (solution), thereby changing its performance or functions.

When the change is higher than the required or expected performance, functions, features, or characteristics to increase the value the system (solution) delivers to stakeholders, we say there is no problem in the system (solution). When the change is lower and decreases the value the system (solution) delivers to the stakeholders than expected, we say a problem exists in the system (solution). What is causing a problem to exist in the system (solution) is called a cause of a problem. The cause of a problem in a system (solution) can also be physiological (physical), psychological, economic, and/or social, like in the case of a system (solution).

Thus, the context matters. It is essential to be clear about what (the system) is meant to help solve problems or perform tasks to achieve the goal. There should also be clarity on what hinders the system (solution) from solving problems or performing tasks it was designed to help achieve the required goal. What hinders is the cause of the problem in the system (solution). In an attempt to eliminate or reduce the existence of a problem in a system (solution) and make the system solve the problem it was designed for effectively, it is important to identify and eliminate what is causing the problem in the system.

For an on-time intervention to bring a system(solution) back on track for increased value delivery, it is important to watch out for symptoms of a problem. A symptom is like an alarm indicating the existence of risk factors (causes of a problem) compromising the system (solution) to make problems exist in it. The risk factors include the system’s hazard and the system’s vulnerability. A symptom could also signify that harm may be occurring in the system and the system is trying its best to fight or protect itself from the harm that hazard is causing.

Harm is the change in a system’s composition or structure, leading to a compromise in the feature or characteristics and performance and functions of a system, decreasing the system’s value delivery. Vulnerability suggests there is a lack of protection by the system, the system is being exposed to hazards, and the system needs or wants something it lacks or is inadequate of, making it further exposed to the hazard with little or no protection.

Suppose there is no symptom (“the alarm”). In that case, the harm caused by the hazard to the system, on the receiving end of the harm, and its vulnerability can increase the problem level in the system to the extreme stage where there is absolute damage to the system. Absolute damage means the system does not have a feature or characteristics needed whatsoever and can not deliver any form of value to its stakeholder(s), i.e., the users or consumers of the system. An example of absolute damage is a human being, a living thing dying, or a machine or structure exploding into aches.

What does a symptom look or feel like? A symptom is exhibited in the form of discomfort, inconvenience, and deficiency in awareness a consumer or user of a system experienced, displayed or tried to cover up. A symptom signifies that a system (solution) if it exists, may not be delivering what it is responsible for. So, several questions should be asked to determine the system (solution) that may have a problem in it when symptoms are observed or measured.

What system (solution) is responsible for preventing or reducing the symptoms? What performance or functions should the system (solution) provide to fulfill the needed responsibility – the set goal of the system (solution) and the reason for the goal? What features or characteristics should the system (solution) have to fulfill the required performance or functions?

Answers to these questions will determine the particular system (solution) having a problem in it to generate the observed or measured symptoms. The answers to the three questions will also provide clarity on the kind of problem it is and what is causing the problem to exist in the system (solution) designed or created to fulfill the responsibility for healthy wellbeing. The answers should be used to generate an intervention (solution) needed to solve the problem in the system (solution). Please be mindful of the context of my use of the word, solution, in what I am sharing with you.

It is important to note that getting the answers can be very challenging, depending on the complexity involved. Because it can be very challenging, people charged with solving a problem often find it convenient to provide intervention (solution) to observed symptoms or the problem the symptoms manifest from if they correctly define the problem. They often do this instead of providing the intervention to reduce or eliminate the cause of the problem in the system (solution).

For someone that knows the difference between symptom, problem, and cause of the problem, the information gathered on the symptoms and the problem manifesting them will be used to determine the causes of the problem in the system (solution). The knowledge will also be used to inform the development of and test the effectiveness of the developed intervention (solution) needed to reduce or eliminate the causes (risk factors) of the problem in the system (solution).

This practice will help ensure sustainable and better outcomes of reducing or eliminating the problem in the system (solution). Directing the intervention toward the symptoms or the problem in the system (solution), instead of the causes of the problem in the system (solution) will not provide sustainable improvement toward achieving the set goal of the system (solution) and the reasons for the set goal. At best, such intervention may be helpful in a short time. Many times, such intervention causes more problems in the system (solution) instead of reducing or eliminating the original problem in the system (solution).

With the use of symptoms to inform what the problem is and put in place on-time and appropriate intervention to the causes (risk factors) of the problem in the system (solution), the risk of damage occurring to the system (solution) can be reduced significantly. The existence of more harm experienced by a system (solution) due to continuous exposure to a hazard will increase the intensity of a problem (damage) in the system (solution).

Similarly, the vulnerability of the system (solution) will increase the intensity of a problem in it. Thus, when addressing the causes (risk factors) of a problem, the focus should be on the nature of the potential hazard present and the vulnerability of the system (solution) that is potentially at the receiving end of the effect (harm) of the hazard.

The nature of the hazard should be assessed based on the likelihood of the potential hazard having the ability to cause harm. The vulnerability should be analysed to determine the potential consequence (impact) a system’s (solution) exposure to the hazard will cause. Higher vulnerability means a higher rate of harm, damage, and absolute damage occurrence.

The focus of the diagnosis effort is to determine, with the guidance of the observed symptoms, the extent of damage (problem) to a system (solution) and determine the causes (risk factors) and how they have contributed and are contributing to the defined problem. Without an accurate diagnosis, i.e., a good understanding of the system (solution) having a problem in it and the causes of the problem, the prognosis will be hard to determine accurately.

Prognosis is the prediction of the likely course and outcome of the system’s problem diagnosed based on available treatment or intervention plans for reducing the likelihood of a potential hazard having the ability to cause harm and the extent of the damage (impact or problem) resulting from the experienced harm, due to vulnerability level of the system (solution). If there is an increase in the severity of the symptoms observed or experienced after the intervention, diagnosis and/or prognosis has not been done effectively.

Let us go back to the health problem, sinusitis, I mentioned earlier to explain the risk factors. The measured or observed symptoms suggesting the possibility of sinusitis will lead to an investigation to confirm (diagnose) the existence of sinusitis and the possible causes (the risk factors) of sinusitis. The causes (risk factors) of sinusitis may include allergies, nasal polyps, structural problems in nasal passages, a weakened immune system, environmental factors, and a recent upper respiratory infection. When someone suffers from sinusitis symptoms, the right thing is to visit a doctor for diagnosis and seek treatments.

Doctors can help to reduce the risk factors. However, doctors can not help to reduce concentrations of indoor air pollutants in the indoor environments of patients’ residences or workplaces. The patients are expected to take the lead in reducing their exposure to indoor air pollutants in the residence or place of work. However, doctors should advise the patients to do so as part of the intervention needed to solve the sinusitis problem. However, if doctors do not know or appreciate the importance of adopting appropriate strategies to improve indoor air quality, the needed improvement to the sinusitis problem will be compromised.

Eliminating the source of air pollutants, adopting ventilation at an appropriate rate, and using air filters or cleaning devices can reduce indoor air pollutants. Non-adherence to these strategies appropriately can cause increased concentrations of air pollutants that can worsen sinusitis (the problem). The elimination of all sources of pollutants in indoor environments is not realistic. Thus, ventilation at an ‘appropriate’ rate is essential. The benefits of ventilation can further be enhanced with air filters and air cleaners.

After setting the premise on how ventilation could influence sinusitis occurrence, Ibrahim started exploring how to conduct research to provide evidence and let people understand how ventilation conditions could influence the severity of sinusitis (sinus infection) and its symptoms. He hoped this could motivate people to make informed decisions regarding adopting ventilation at an appropriate rate. He thought of how to programme and develop artificial intelligence (AI) – based computer simulation software for predicting the relationship between ventilation and sinusitis and its symptoms and testing how the software could accurately simulate real-life conditions. He started his research endeavour with five research questions.

•    How would variation in ventilation rate impact the severity of sinusitis and its symptoms?

•   How would the presence of air pollutants in an indoor environment influence the severity of sinusitis and its symptoms?

•    To what extent can self-reported and objectively measured sinusitis symptoms correlate?

•    To what extent can AI-based simulated and laboratory-based experiments on the impact of ventilation rate and air pollutants on the severity of sinusitis and its symptoms correlate?

•    How would pre-existing sinusitis and its symptoms influence the impact of ventilation rate and exposure to air pollutants on objectively measured severity of sinuitis and its symptoms and their perceived indoor air quality?

While still in a coma, Ibrahim visualised himself conducting the following research with his team.

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Participants were recruited through a public advertisement. The advertisement described the study, and interested individuals were required to contact the research team. Participants were required to be above 18 years. Two sets of participants were recruited for the study. The two sets were healthy and non-healthy subjects.

Healthy subjects had no history of sinusitis and allergies, while non-healthy subjects had a history of diagnosed sinusitis. Participants were screened to ascertain the required participation requirements. They were also screened for medications like a chronic respiratory disease that may compromise the research studies.

Experiments for thirty healthy and thirty non-healthy subjects were conducted in two field environmental chambers. The two chambers’ air conditioning systems and experimental conditions were identical. Each set of subjects participated in a total of 6 experiments. The experimental matrix for the research study was 3 x 2 x 2, i.e., three ventilation conditions, two air pollutant injection scenarios, and two sets of subjects.

The ventilation conditions were no ventilation (Nv), lower ventilation rate (Lv), and higher ventilation rate (Hv). Hv value was in the range of the required ventilation rate in a residential apartment. Lv value is half of Hv. Air filters were placed in the air conditioning system to purify the outdoor air transported into the chambers. The two air pollutant conditions were no ozone and limonene injection into the chamber and injection of ozone and limonene into the chamber. Ozone and limonene injection lasted for the 4-hour duration of the experimental period. Concentrations of ozone, limonene, secondary organic aerosols (SOAs), and other oxidation products formed from ozone-limonene chemistry were measured throughout the experimental period.

Subjects were required to perform sedentary activities of their choice as this was unimportant to the study. Subjects were required to fill in survey questions immediately after entering the chamber and just before they left the chamber regarding their perceptions of sinusitis symptoms. The survey questions assessed subjects’ perceived nasal congestion, facial pressure or pain, headache, runny nose, throat irritation, fever, cough intensity, and bad breath.

The assessment ratings of nasal congestion range from ‘no congestion’ to ‘severe congestion’ on a scale of 0 to 100. The ratings for facial pressure or pain, headache, runny nose, throat irritation, cough intensity, and bad breath had similar assessment scales but from “no…” to “severe….”. Subjects were given three options in the subjective assessment of fever: ‘normal’, ‘high’, and ‘severe’. Subjects were also tasked to assess their perceived indoor air quality immediately after entering the chamber (P1), mid-way through their stay in the chamber (P2), and just before they left the chamber (P3).

A portable computer tomography scanner was used to scan each subject’s face, scanning the cheekbones, forehead, and nose to provide detailed information about the severity of the sinusitis symptoms of interest addressed in the survey questions in less than a minute. Technology was very advanced to achieve this feat. Technological advancement also made it easier for the sophisticated CT scanner to be affordable and easily available. Twelve such scanners were deployed for the research study. The CT scanner also provided detailed information on sinusitis (sinus infection) through measurements of the severity of swelling, readiness, and tenderness of the sinus lining.

Participants were compensated for their time and effort in participating in the study. Participants were informed about the purpose of the study and had the right to withdraw at any time. Informed consent was obtained from all participants. Participants’ confidential information and privacy were maintained throughout and after the research study. As the research leader, Ibrahim ensured all research procedures complied with the ethical standards set by relevant institutional review boards (IRBs) and got the IRB’s approval to conduct the research.

The change in Ibrahim’s brain neurons due to the head injury he sustained and subsequent brain surgery had also made him easily visualised and got ideas on how an AI-based simulation software could be programmed to generate a human model with all the known physiological and psychological systems in the human body and with their known response to known stimuli that human body and its systems react to under different possible scenarios.

The data and information generated from the AI-based simulation tool could easily be sent to desktop-based and mobile digital devices in real-time. He used AI-based simulation software he developed to recreate the laboratory experiment with better control of the variables in the experiments. The AI-based simulation software was revolutionary. The following were the key observations from the study conducted.

– How would variation in ventilation rate impact the severity of sinusitis and its symptoms?

•    An increase in the ventilation rate lowered the severity of sinusitis objectively measured. An increased ventilation rate also lowered sinusitis symptoms in the symptoms measured objectively in and perceived by the healthy and non-healthy subjects. The observation was consistent for both ‘air pollutants’ and ‘no air pollutants’ injection experiments.

•    The difference between the higher ventilation rate (Hv) and the lower ventilation rate (Lv) was significant for the ‘air pollutants’ injection experiments but not significant for ‘no air pollutants’ injection experiments.

•    Non-provision of ventilation (Nv) in the chamber significantly worsened the severity of sinusitis and its symptoms than both Hv and Lv experiments for both ‘air pollutants’ and ‘no air pollutants’ injection experiments.

– How would the presence of air pollutants in an indoor environment influence the severity of sinusitis and its symptoms?

•    Increase in the concentrations of ozone, limonene, SOAs, and other oxidations products positively correlated with an increase in the severity of sinusitis and its symptoms measured objectively in and perceived by the healthy and non-healthy subjects.

•  ‘Air pollutants’ injection experiments had the severity of sinusitis, its symptoms measured objectively and perceived by healthy and non-healthy subjects worsened significantly than experiments with ‘no air pollutants’ injection experiments.

– To what extent can self-reported and objectively measured sinusitis symptoms correlate?

•  Healthy and non-healthy subjects’ perceived sinusitis symptoms positively correlated with those objectively measured. The correlation was very high.

– To what extent can AI-based simulated and laboratory-based experiments on the impact of ventilation rate and air pollutants on the severity of sinusitis and its symptoms correlate?

•    The AI-based simulated experiments’ observations were similar to the laboratory-based experiments. As expected, there were fewer confounds and uncertainties in the data collected from the AI-based experiments than from the laboratory-based experiments.

•    The concentrations of measured air pollutants in the AI-based experiment were not significantly different from that of the laboratory-based experiments.

•  These findings suggest the potential for using the developed AI-based simulation software to generate very reasonable and realistic experiment data in academia and the healthy buildings delivery industry. Doctors can also use it to aid their diagnosis and prognosis of human health problems.

– How would pre-existing sinusitis and its symptoms influence the impact of ventilation rate and exposure to air pollutants on objectively measured severity of sinuitis and its symptoms and their perceived indoor air quality?

•    For all experiments, non-healthy subjects’ perceived severity of sinusitis symptoms was significantly higher than healthy subjects’ perception. The same findings were observed in the case of objectively monitored severity of the sinusitis symptoms. The severity of sinusitis symptoms measured objectively was significantly higher than those perceived. Perhaps, other human factors influenced the human assessments.

•    Interestingly, non-healthy subjects perceived air quality immediately after entering the chamber (P1), midpoint during the stay in the chamber (P2), and before exiting the chamber (P3) were significantly lower than healthy subjects’ perceptions (P1 to P3). It seems pre-existing sinusitis conditions inhibited non-heathy subjects’ perceived indoor air quality. This is a concern because it seems that while humans suffering from sinusitis and its symptoms cannot perceive the poor air quality of their indoor environment appropriately, the air pollutants in the indoor air may be causing harm to their physiological conditions.

•    The effect of the measured ozone, limonene, and their initiated chemistry products and decrease in ventilation rate in increasing the severity of sinusitis was significantly higher in the non-healthy subjects than healthy subjects.

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Ibrahim woke up from his coma after four months and spent an additional month in the hospital before he was discharged. Ibrahim followed his father to his home country, Nakum, to recuperate. He spent nearly six months in his home county to get on his feet. He took a long leave of absence to get better. During his six-month recuperation period, Ibrahim developed his Ph.D. research proposal and sent it to Prof. Kim, his Ph.D. supervisor. The proposal was based 100% on the research Ibrahim visualised while in a coma. Ibrahim could remember everything because he now has an extra high memory level.  

At this point, he had become an extra high-level genius. He could remember anything he saw, read, and listened to forever if he wished to remember them. His rate of generating experience, i.e., knowledge, understanding, and skills, from any information he was exposed to was extraordinary and humanly unbelievable. With the support of his supervisor, Professor Kim, a multi-million-dollar research grant proposal written by Ibrahim was submitted and granted by a government agency for the research to be conducted. Ibrahim developed the AI-based simulation software he got the idea of when he was in a coma.

For context, developing such revolutionary software would take at least ten years for a large team of brilliant people. Ibrahim developed programmes for generating the software and built it within the six months he spent in his home country. He returned to Eastland to finish his Ph.D. study with the support of research assistants funded through the research grant.

Professor Kim and everyone that knew Ibrahim before the plane crash was blown away by the extra high-level genius cognitive ability he was displaying. Ibrahim was like a magician to them. Unsurprisingly, the government was willing to invest multi-million dollars into the proposed research project. Even Ibrahim could not believe his cognitive ability. Key conclusions from the research study were the same as the ones Ibrahim saw in his coma.

The findings from the research initiated by Ibrahim were widely accepted and celebrated in academia. Ibrahim’s intelligence and scholarship ability were highly respected, and he got a faculty position as an Associate Professor at Bernard University in a country called Afeobuna. Afeobuna was a high-income economy and one of the world’s most powerful countries. To put things in context, fresh Ph.D. graduates would get a post-doctoral job after Ph.D. graduation and proceed to be an assistant professor, if lucky, after a few years in a post-doctoral job, if very brilliant.

It would take at least six years to get promotion from an assistant professor position to an associate professor position if the candidate applying is brilliant and has produced numerous scholarly outputs. For context, getting promoted to an associate professor position was extremely difficult at Bernard University. Bernard University was ranked the best in the world.

The competition for promotion at the university was unbelievable, and a place at the university was reserved for people with a natural aptitude to spend most of their time on academic activities, doing research, and generating world-class scholarly outputs. All faculty at Bernard University were and still are extremely brilliant if not geniuses. Before graduating from the Ph.D. programme, Ibrahim had written six books and more than 100 scholarly and thought-provoking articles. He could not help himself. Writing became second nature to him.

An article that would typically take a brilliant scholar to write in several months would take Ibrahim a week or less. A book that would take several years to write would take Ibrahim two months or less. Ibrahim’s cognitive ability, with no visible side effects, had never been seen. For Ibrahim to be employed as an associate professor directly from graduate school means Bernard University wanted him and could not afford to let the chance of recruiting him to slip off.

Many universities tried to recruit by making high-level offers they would not imagine offering to someone just graduating from graduate school. In fact, Ibrahim got his job offer to work at Bernard University a few months before he completed his Ph.D. study.

Within two years, Ibrahim was promoted to full professor. He had written over twenty books and over four hundred articles by this time. He was highly respected in academia. While Ibrahim was highly respected and celebrated in academia for his brilliance, groundbreaking research works, and scholarly output on the importance of ventilation to human health, his work did not translate to a change in the poor attitude toward appropriate ventilation rate adoption in the industry and community.

In one of his classroom lectures at Barnard University, Professor Ibrahim Cisse told his students how medical doctors failed to consider the importance of ventilation when trying to diagnose a health problem the student (a patient) was suffering from and come out with a good prognosis. Prof. Ibrahim Cisse told the story as follows.

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After diagnosing a patient with sinusitis, doctors thought the prognosis was very good as the patient did not have chronic sinusitis. Doctors prescribed nasal saline irrigation, steam inhalation, rest, and hydration. To the surprise of the doctors, the diagnosed acute sinusitis, which was re-occurring, developed into chronic sinusitis.

The newly diagnosed chronic sinusitis prompted the doctor to change the course of treatment from non-medical to medical. The doctors prescribed antibiotics, decongestants, steroid nasal sprays, pain relievers, and surgery to reconstruct the sinus. Unfortunately, a few months after every medical treatment and signs of improvement, the chronic sinusitis worsened severely. The doctors must be missing something. “What do you think they are missing?” Professor Ibrahim Cisse asked.

To reduce the risk of further damage to the patient’s sinus, the doctors provided the patient with solutions that could reduce the patient’s sinusitis problem. But they did not account for what was causing the sinusitis and the lack of protection from it.

“What is the hazard causing sinusitis?” Professor Ibrahim Cisse asked. Contaminated indoor air! The patient, who was a student, after taking this indoor air quality module, realised how chemical and biological (mold, bacteria, virus, etc.) based particulate matter and gaseous air pollutants in the indoor air when in contact with the numerous immune cells in the sinus lining can trigger the immune response to produce inflammatory molecules.

The released inflammatory molecules cause blood vessels in the sinus lining to be dilated. The dilation causes swelling, more mucus production, and pain, which are signs of inflammation in the sinus. When the contaminated indoor air is not cleaned, sinus inflammation will persist, irrespective of treatments.

The risk will be high, especially for someone suffering from pre-existing conditions like allergies, nasal polyps, sinus structural abnormalities, infections, and immune system disorders, as the conditions will cause the overreaction of immune cells to air pollutants. Whether or not an individual is susceptible to sinus inflammation and sensitive, the use of an appropriate ventilation rate, especially with air filters, cleaners, or purifiers, can significantly reduce the risk and severity of sinus inflammation occurrence.

After learning from my IAQ module, the patient improved the ventilation rate and air movement in her apartment, especially in her air-conditioned bedroom. She improved the ventilation rate in her kitchen and avoided the usually moist and dirty clothes, bedding, linens, carpets, upholstery, mattress, and pillows in her bedroom. Her sinusitis symptoms reduced significantly, and her sinusitis status moved from chronic to mild. 

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The practice of not taking ventilation seriously in the industry and community changed for the good when there was a global pandemic of very contagious viral infections. At this point, people from all spheres of life had no choice but to adopt ventilation at the appropriate rates in their buildings or indoor environments. Ibrahim became an overnight celebrity in the industry and community locally and globally. His research, AI-based simulation software, and other innovations he and his team had developed saved many lives.

Ibrahim’s AI-based simulation software was commercialised and became a dollar millionaire overnight. Ibrahim’s AI-based simulation software became a very popular and important software used during the design and management of buildings and indoor environments of any kind. It was also and still used to aid the productivity of medical practices.

Ibrahim became a celebrity to the extent that the Maneburg government and its embassy in Eastland made public apologies to Ibrahim, who is now a well-respected professor after he shared a story of how he was discriminated against in the Maneburg Embassy in Eastland when he was a Ph.D. student and how that led to him being involved in a plane crash in an interview in a global news network.

Ibrahim’s claim was verified by many people, including Professor Arun Kim, at the University of Rolland at Eastland. To further reduce the intensity of the backlashes the Maneburg and its Embassies in Eastland and around the world were receiving, the Maneburg government named a street after Ibrahim and gave him honorary citizenship.

The street was called Professor Ibrahim Cisse Street. Ibrahim’s name was and still is on a street of a country he was refused entry to as a Ph.D. student because an embassy staff at the embassy believed he was from a dangerous country. As a professor and a highly respected person worldwide, Ibrahim travelled around the world freely despite the fact he was still using his Nakum passport, which required him to apply for a visa to almost every country in the developed countries. Ibrahim only used his Afeobuna passport when he was hurrying to travel out of Afeobuna. Ibrahim was blessed with a beautiful wife and children. The End.