Indoor Air Cartoon Journal

Indoor Air Cartoon Journal, August 2023, Volume 6, #145

[Cite as: Fadeyi MO (2023). Impact of exposure to indoor air pollutants on foetal neurodevelopment and cognitive function. Indoor Air Cartoon Journal, August 2023, Volume 6, #145.]

Fictional Case Story (Audio – available online) 

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There were growing negative behaviours, including bullying, hatred, and prejudice towards foreigners in a country called Mandiyun. The poor public health in Mandiyun contributed to fear in her citizens and fueled their negative behaviours toward foreigners. Exposure to poor indoor air pollutants that contributed to poor public health was a root cause of the negative behaviours. However, this reality was unknown. It took a girl whose family was a victim of negative behaviours to embark on research to bring the unknown reality to people’s consciousness. The research was designed to answer the question, how does adopting ventilation and air cleaner impact indoor air quality and reduce pregnant women’s exposure to indoor air pollutants, and what are the potential implications for foetal neurodevelopment and cognitive function? The research done by the girl led to a journey of bridging the gap between health and empathy in Mandiyun and around the world. The journey of the girl is the subject of this short fiction story.

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A young girl named Amira Kano was born in a small and poor village called Trujan in a developing country called Fantwana, where she was brought up with the values of compassion, understanding, and the belief that goodness resided in the hearts of people everywhere. Amira’s family had always been a close-knit and harmonious unit. They lived in a quiet neighbourhood where neighbours warmly greeted each other and exchanged stories showcasing their shared humanity. Amira’s parents had instilled in their children, Amira and Amir, the values of tolerance, empathy, and the power of education.

Amira and her family’s life took a sharp turn when they moved to a foreign country called Mandiyun in search of better opportunities. Mandiyan is a rich country. Excitement mingled with apprehension as they embarked on a new chapter in their lives. But the warmth of anticipation soon gave way to the harsh reality of bully, hatred, and prejudice.

It was during a routine day at school the fabric of Amira’s world began to unravel. She faced teasing, isolation, and hurtful comments solely based on her background. The pain of prejudice struck her like an unexpected storm, leaving scars on her heart that no time could fully heal.

The turning point came when Amira’s family became victims of a tragic incident rooted in ignorance and prejudice. The incident shattered their lives, leaving them broken but not defeated. It was during this time of grief that Amira’s determination to create positive change took root. A local extremist group committed devastating acts of violence, targeting their home simply because they were of a different ethnicity and practiced a different faith. Ignorance and prejudice had fueled this senseless act, leaving the family’s home vandalised, their sense of security shattered, and their spirits deeply wounded.

Amira’s family found solace amid the wreckage and pain in each other’s embrace. They refused to let fear and bitterness define their response. While the tragedy broke them, they were not defeated. During this time of grief, Amira began to exhibit an extraordinary strength of character.

Amira, previously a quiet and studious teenager, was stirred by the injustice her family had endured. She immersed herself in researching history of prejudice and how it has shaped societies. She learnt about the lives of those who had fought against discrimination and intolerance, drawing inspiration from their stories of resilience.

Amira’s determination to honour her family’s suffering by creating positive change took root within her heart. With unwavering resolve, she encouraged her parents and brother to start engaging in open dialogues with people in the community, inviting them to learn about different cultures and religions. Through conversations and educational events, Amira and her family aimed to break down the walls of ignorance that had allowed the tragedy to occur.

Amira, who had always been a talented artist, channeled her emotions into her work. She began creating powerful pieces that depicted unity, diversity, and the strength of the human spirit. She continued community engagement even when she was admitted to the prestigious National University of Mandiyun (NUM) to study in the BSc in Engineering Science programme. NUM was one of the top 10 universities in the world. Amira graduated with First Class Honors despite her busy schedule juggling her studies and community engagements.

As time passed, Amira’s family established a foundation in memory of the tragedy they had endured. The foundation’s mission was to promote understanding, tolerance, and acceptance among diverse communities. Amira and her family’s efforts to educate only made very little improvements in their neighbourhood, while the negative behaviour toward foreigners persisted throughout the country. Amira refused to be defeated.

Amira thought that maybe she was not addressing the root cause of the problem. She changed her strategy from providing a solution to a problem to understanding the reason for the negative behaviour towards her family and other foreigners. From her observations, reflections, and investigations, Amira realised that the barrage of poor public health incidents the country faces could be the source of citizens’ resentment toward foreigners. Below are some things Amira learnt from her observations, reflections, and investigations.

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The citizens of Mandiyun witnessed a significant increase in poor cognitive function and neurodevelopment in their children. They became anxious about their children’s future and well-being and looked for reasons behind these challenges. They sought explanations from health professionals and the government but did not get satisfying answers. Without accurate information, parents and communities rely on stereotypes or misinformation to explain these challenges. This resulted in the scapegoating of foreigners.

The poor public health prevalent in the country led to resources being limited and strained. With limited resources in their minds, citizens perceived the influx of foreigners as a threat to their already scarce resources, leading to negative attitudes and behaviours. Many citizens viewed foreigners’ use of these facilities as further depleting already limited healthcare resources.

The poor public health prevalence in the country led to economic challenges and job scarcity. There was high unemployment in the country. Thus, many citizens saw newcomers as competition for employment. Many citizens resent foreigners seeking jobs, perceiving them as taking away potential employment opportunities, exacerbating negative feelings.

There was a time when a virus outbreak caused major public health problems, leading to increased illness. Many citizens scapegoated foreigners, believing they had introduced new diseases to their country. Many citizens’ fear got so bad that they stigmatised foreigners as the source and the cause of disease transmission. Many citizens interpreted foreigners’ behaviours through a negative lens due to unfamiliarity. For example, some citizens misinterpreted foreigners’ cultural practices related to health and hygiene as careless or unclean behaviour, leading to bullying, hatred, and prejudice. With limited resources and challenges, an “us vs. them” mentality developed.

There was a higher prevalence of respiratory and cardiovascular problems in the country than previously experienced. The unprecedented public health problems led some citizens to believe that the influx of foreigners into their country is leading to an increase in population, leading to an increase in traffic and traffic air pollution, known to be a major contributor to respiratory and cardiovascular problems. As a result, some citizens banded together against perceived outsiders, furthering divisions and promoting negative behaviours.

Due to dealing with their own health struggles, some citizens had less capacity for empathy towards foreigners facing different challenges, such as adjusting to a new culture, language barriers, and economic challenges. The lack of empathy caused bullying, hatred, and prejudiced attitudes. For example, the struggles with high rates of illness, lack of access to medical care, and a general feeling of vulnerability caused some citizens to become consumed by their health issues, constantly worried about their health and well-being and their families. The constant fear of falling ill and the stress of navigating a broken healthcare system made them more inward-focused and less attentive to the needs and challenges of others.

The daily battles with poor health limited their emotional capacity to connect with the experiences of others. In this scenario, their lack of empathy did not necessarily stem from malicious intent but rather from the overwhelming circumstances they themselves were grappling with. They might have unintentionally dismissed the struggles of the foreigners and even developed prejudiced attitudes based on their own preoccupations.

Politicians exploited poor public health for their own gain. Some politicians blamed the perceived poor public health condition on foreigners, amplifying negative sentiments and further strengthing their bullying, hatred, and prejudiced behaviours. These politicians capitalised on some citizens’ resentment towards foreigners for their gain. By directing citizens’ frustration towards a common enemy, the politicians created a sense of unity and purpose among the population, even if that unity was built upon negative sentiments. The politicians used inflammatory rhetoric to create a narrative that portrayed foreigners as the root cause of the health problems.

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The understanding motivated Amira to want to contribute to reducing negative behaviours toward foreigners through improvement to public health, as she and her family were victims of bullying, hatred, and prejudice. Amira decided to pursue an MSc degree in Public Health with the belief that she could contribute in her little way to improving public health in the country in the hope of reducing bullying, hatred, and prejudice. As Amira pursued her MSc degree in Public Health, her passion for making a tangible impact on people’s lives grew stronger. During her studies, she discovered a hidden passion for indoor air quality and health.

Amira’s interest in indoor air quality was ignited during a lecture on environmental health, where she learnt about the significant health risks posed by indoor air pollutants. As she delved deeper into the subject, she realised that poor indoor air quality could have far-reaching consequences, particularly for vulnerable populations such as pregnant women and their unborn children. This revelation struck a chord with her, as she had always been drawn to research that had the potential to create meaningful change.

Amira’s dedication to her studies and newfound interest in indoor air quality soon became evident in her academic achievements. She excelled in her coursework, engaging actively in discussions and demonstrating a keen understanding of the complex intersections between health, environment, and society. Her inquisitive nature and her ability to critically analyse research findings impressed her professors.

As Amira’s MSc journey progressed, she seized every opportunity to contribute to research projects related to indoor air quality as a research assistant. Her dedication did not go unnoticed. Amira’s commitment to the projects was rewarded with a highly competitive scholarship that enabled her to pursue a PhD degree in Public Health.

The scholarship not only recognised her academic excellence but also acknowledged her potential to drive innovation in the field of public health. Amira decided to examine the impact of exposure to indoor air pollutants on foetal neurodevelopment and cognitive function for her PhD thesis. Amira’s PhD study was supervised by Professor Josephine Jacob, a world-renowned public health scientist, educator, and innovator with a core interest and expertise in indoor air quality and health.

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Amira had several discussions with Professor J Jacob during the development of her PhD thesis proposal. The research proposal written by Amira, with guidance from her PhD supervisor, Professor J Jacob, was submitted for a research grant. With the support and scientific standing of Professor J Jacob and the perceived high quality of the research proposal by the research grant committee, a 10 million dollars international research grant was secured to conduct the research study. Amira’s research was driven by three fundamental research questions that drove the objectives of her Ph.D. study. The research questions are:

(i) How does using air cleaners influence pregnant women’s exposure rate to indoor air pollutants and the risk of foetus experiencing poor neurodevelopment and cognitive function? (ii) How does a change in ventilation rate influence pregnant women’s exposure rate to indoor air pollutants and the risk of foetus experiencing poor neurodevelopment and cognitive function? (iii) How does a change in the clean air delivery rate (CADR) for particulate matter removal and gaseous air pollutant removal efficiency of air filters influence pregnant women’s exposure rate to indoor air pollutants and the risk of foetus experiencing poor neurodevelopment and cognitive function?

Experimental studies were conducted to examine the relationship between the noted variables and find answers to the three research questions. Her Ph.D. study was anchored on three objectives informed by the research questions. She designed experimental methods to answer the research questions and fulfill her research objectives.

Participants for the research study were recruited from a diverse group of pregnant women who reside in various environments (urban, suburban, rural) in the country and have different levels of indoor air pollutants exposure. All the participants chosen did not have any form of air cleaners (filters or air purifiers) in their apartment units. All the pregnant women joined the research study when they were less or equal to 8 weeks pregnant. Each participant’s participation in the experimental study ended when they gave birth.

To recruit participants for the study, the National University of Mandiyun, under the leadership of Professor J Jacob, who was supervising Amira’s PhD study, collaborated with prenatal clinics, hospitals, and community centers to identify pregnant women who meet the study’s criteria.

The key criteria were (i) the pregnant mother should not have a pre-existing health problem that could compromise the health of the foetus or make the pregnancy risky, (ii) the pregnant mother should not be a smoker, (iii) a participating pregnant mother should be within the age of 25 and 35 years, (iv) a participating mother should typically spend more than 10 hours per day in the apartment to be used for the study, and (v) a participating pregnant mother should not be engaging in work or in a workplace predominately known to expose workers to toxic air pollutants.

Informational sessions were conducted to explain the study’s purpose, procedures, and potential benefits and risks. Efforts were made to ensure participants had ample time to ask questions and make informed decisions before consenting to participate. An Institutional Review Board (IRB) approval was obtained to proceed with the research study. 105 participants were recruited for the study and were equally distributed to the three groups. However, a total of 30 to 32 participants per group completed the study successfully. Only the data of participants who successfully completed the study were used in the data analysis.

The participants were randomly grouped into three categories – Control group, Intervention 1 group, and Intervention 2 group. The main difference between these groups is the air filter (an example of air cleaners) adoption status in the apartment units of the participants.

The interventions in the Intervention 1 group and Intervention 2 group were done by providing air filters. Thus, no air filter was provided for the households of participants in the Control group. Participants in the Intervention 1 group and Intervention 2 group were provided with high-efficiency particle air filters and high-efficiency particle air filters impregnated with activated carbon, respectively.

In apartments where air filters were provided as part of the intervention effort, the research team helped maintain the air filters and replace them where necessary to ensure the clean air delivery rate (CADR) and gaseous air pollutants removal rate were similar to what would be expected for the new version of the air filters used.

Computer-generated randomisation was adopted to allocate participants to each group to minimise bias. Randomisation was also done to ensure that the potential bias was distributed evenly across the groups, minimising the impact of variations in indoor source emission strength of air pollutants and outdoor air pollution conditions.

The following were measured to answer the research questions: (i) indoor air pollutants exposure rate of the pregnant women that participated in the study, (ii) risk of poor neurodevelopment occurrence, (iii) risk of poor cognitive function occurrence, (iv) air filter’ clean air delivery rate (CADR), (v) air filters’ gaseous air pollutants removal efficiency.

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Exposure rate is the average concentration of an indoor air pollutant participants were exposed to divided by the sample duration of the indoor air pollutant. The unit of exposure rate depends on the unit of the sampled air pollutant. For example, the unit of PM_2.5 is µg/m³. In this case, the exposure rate unit is µg/m³h.

The indoor air pollutants of interest are combustion-related. The measured air pollutants were PAHs (Polycyclic aromatic hydrocarbons), PM_2.5, PM₁₀, CO₂, CO, NO₂, SO₂, O₃, and TVOCs. Exposure sampling was done in proximity to the participants. An innovative ArtificiaI Intelligence-based IAQ measuring instrument previously developed by Professor J Jacob was used for the sampling.

The IAQ instrument was so small that it could be worn like a necklace without compromising the comfort and convenience of the person wearing it. The water-resistant AI-based IAQ instrument contained sensors that measure air pollutants of interest. It means participants could wear the IAQ instrument as a necklace everywhere, even when swimming or bathing. The IAQ instrument could also measure environmental parameters like temperature, relative humidity, and airflow.

This kind of IAQ measurement was chosen for this study to do measurements in proximity to participants as much as possible. The IAQ instrument was programmed to detect when a participant is inside and outside the household of interest. Thus, measured data was categorised into “inside” and “outside.”

The category was done to adjust for the possible impacts of participants’ exposure to air pollutants when they are outside their households used for the research study. Only data for the “inside” was needed. The IAQ instrument also had the capability to identify sources of measured indoor air pollutants and the source strength. Thus, it made it possible to determine the source strength index in each household for any duration of interest. The source strength index was done for each air pollutant of interest.

The capability of the IAQ instrument made it possible to monitor IAQ conditions in the households of the participants in real-time. The AI capability of the IAQ instrument also made it easier for the instrument to calibrate itself accurately without any human intervention. The IAQ instrument was innovative and sophisticated and the first of its kind at that time.

The IAQ instrument was able to transmit measured data to any mobile and non-mobile digital device of choice wirelessly. It could also transmit data to the cloud. In this study, measured IAQ-related data by the IAQ instrument was sent to an AI-based central data aggregation and integration hub placed in the household of each participant.

The hub automatically and wirelessly sends data to the cloud and digital devices in real-time, making it easier for Amira and her team to monitor the research in real-time. The hub was programmed to provide data for exposure rate for when the participants were inside their households, exposure rate for when they were outside their households, and combined exposure rates for inside and outside of the participants’ households.

The hub is also programmed to determine the risk of poor neurodevelopment and poor cognitive function occurrence due to exposure rate data measured inside the household, outside the household, and both combined. However, the data from inside the household was reported in Amira’s PhD thesis.

A scatter plot of exposure rate data for all the participants that completed the study on the x-axis was plotted against the risk of poor neurodevelopment occurrence to their foetal on the y-axis. Each plot data point has an exposure rate and a corresponding risk value. The duration used for computing the risk value is the same as the duration used in the computation of the exposure rate. For example, the exposure rate was based on an average of every 14 days of exposure to an indoor air pollutant, and the computed risk value was based on every 14 days of exposure to an indoor air pollutant.

That is, the data point for each participant is after every 14 days throughout the participation in the study. The total data point for each participant varies as their starting point and duration of the pregnancy vary. The data points for each of the 92 participants who completed the study were plotted on the same plot, irrespective of their groupings. However, they were colour-coded.

A line of best fit was drawn through the maximum number of data points for participants in each of the 3 groups – Control group with no air filter, Intervention 1 group with particle air filter, and Intervention 2 group with particle air filter impregnated with activated carbon. The purpose of drawing the line of best fit is to provide an easy visual comparison of the risk level caused by the corresponding exposure rate for the three groups. The plot was done for each air pollutant measured in the study. The whole process of plot development was also done for the risk of poor cognitive function occurrence.

The following processes were involved in the calculation of the ventilation rate. An AI-integrated anemometer was placed at windows to measure air velocity and sent continuous data to the AI-based central data aggregation and integration hub. The data from the anemometer was sent to the hub through wireless communication protocols, like WiFi and Bluetooth. The anemometer also had the capability to self-calibrate.

Laser sensors in each household of the participants were used to determine the dimensions of window openings and indoor surfaces. The cross-sectional area of a window is calculated in the hub when data on the area is sent into it. The hub calculated the airflow rate through a window by multiplying the measured air velocity by the cross-sectional area. Data from the laser sensors also aided the determination of room volume. The hub calculated the ventilation rate in ACH, i.e., air changes per hour, for each household by dividing the airflow rate by the room volume..

The ACH used in this study is the ACH for the whole household. The ACH data was generated in real-time. The calculation assumed uniform air distribution. Factors such as air leakage, air mixing, or the presence of obstacles that might affect the actual ventilation rate were not considered in the calculation. The calculation method introduced some level of uncertainty in the calculated ventilation rate, albeit very representative.

Data points in each of the 3 groups for the study were categorised into two to answer research question 2 based on the average ventilation rate for a whole house during the 14 days for computing a data point. The two categories, “lesser than” and “greater or equal to” whole house ventilation rate of 0.35 ACH, were compared on a plot. The plots for the Control, Intervention 1, and Intervention 2 groups were separated. The exposure rate on the x-axis was plotted against the risk value on the y-axis for each plot.

For the plot for each group, a line of best fit was drawn to visually compare data points of “lesser than” and “greater or equal to” whole house ventilation rate of 0.35 ACH. The plot was done for the risk of poor neurodevelopment occurrence and the risk of poor cognitive function occurrence for each of the pollutants of interest in Amira’s PhD study.

The clean air delivery rate (CADR) was calculated by dividing the volume of particles an air cleaner (e.g., an air filter unit) removed from the indoor air by the time taken to do the removal. In this study, the CADR calculation was done only for PM_2.5 and PM₁₀, as CADR is used to measure the effectiveness of an air cleaner (e.g., an air filter unit) in removing particles from the indoor air.

A simultaneous and continuous particle measurement was done before and after an air filter unit in the households of the participants. A particle measurement sensor was placed before and after an air filter unit to carry out the measurements. The recorded data was sent to the data aggregation and integration hub. The CADR calculation was done in the hub. Particle removal by an air filter unit was calculated by subtracting particle concentration after an air filter unit from the particle concentration before the air filter unit.

The net particle concentration was multiplied by the air volume, which is the volume of the room, to get the volume of the particles removed. The calculated particle volume was divided by the time taken for the air filter unit to remove particles from the air flowing through it to get the air filter unit’s CADR. The CADR for the air filter units used in the Intervention 1 and Intervention 2 groups was determined before the actual field experiments started. CADR was also calculated in real-time throughout the study to ensure consistency in the expected CADR for the particle filter types adopted.

The adopted particle filters and particle filters impregnated with activated carbon in Intervention groups 1 and 2, respectively, were replaced every 3 months. This was done to ensure the CADR throughout the study for each air filter type was maintained close to the expected CADR for a new version of the filter types. The fan speeds for both air filter types were set to be the same and kept constant throughout the study.

The concentrations of gaseous air pollutants of interest in this study were simultaneously and continuously measured before and after the filters. The gaseous air pollutants were measured simultaneously with the particle concentrations. Like in the case of particle concentration, gaseous air pollutants data was sent to the data aggregation and integration hub for the gaseous air pollutant removal efficiency calculations.

The concentration after the air filter unit was subtracted from the concentration before the air filter unit. The gaseous air pollutant removal efficiency for the filter types was determined by dividing the net gaseous air pollutant concentration by the gaseous air pollutant concentration before the air filter unit and multiplied by 100.

A wearable MRI, called WareMRI, previously developed by Professor J Jacob, was used in this study. The WareMRI was a revolutionary wearable MRI device tailored for pregnant women to monitor foetal neurodevelopment and predict their potential cognitive abilities through advanced imaging and AI analysis.

The wearable MRI resembles a sleek, lightweight, and ergonomic device that can be comfortably worn on the body. WearMRI is constructed from lightweight yet durable materials that are non-magnetic and safe for extended contact with the skin. Medical-grade fabrics are used to ensure comfort and safety. To ensure safety, the WearMRI has fail-safe mechanisms that immediately halt imaging if any abnormal conditions are detected. It has mechanisms to prevent interference with external magnetic fields.

The features of WearMRI include brain imaging sensors, secure wireless connectivity, real-time imaging, AI-driven neural analysis, interactive visualisation, longitudinal tracking, cognitive potential prediction, user-friendly experience, and data security and privacy. WearMRI is designed, developed, tested, and validated to be safe for the foetal and the pregnant woman using it.

WearMRI has shielding materials that attenuate the magnetic fields generated by the device. Participants were required to use the WearMRI two times a week to alleviate any potential concern of magnetic field concerns from the participants. Participants were required to use the WearMRI for 4 hours every time they used it.

WareMRI incorporates miniaturised MRI sensors designed explicitly for foetal brain imaging. These sensors are placed strategically on the wearable device to capture detailed neural activity and growth patterns. The wearable connects seamlessly to a paired smartphone or tablet through a secure wireless connection. A dedicated app provides an interface for real-time imaging, data storage, and AI analysis.

WareMRI allowed Amira and her team to capture real-time MRI images of the foetal brain, tracking neural connections, growth, and activity patterns as they unfold during pregnancy. The physiological condition of the foetal and the concentration of air pollutants detected in the foetal was used to compute the risk.

The sophistication and the AI capability of the WearMRI made the computation of the risk specific to each air pollutant of interest possible. Rigorous validation and clinical trials had been done in previous studies conducted by Professor J Jacob to establish the accuracy of cognitive predictions of the WearMRI. The accuracy of data provided by WearMRI was also validated by Amira in her PhD study, which was specific to exposure to indoor air pollutants.

Given the sensitivity of the data, WearMRI was designed to ensure robust encryption and secure data storage to protect the privacy of both the foetus and the parents. The data generated by WareMRI was also sent to the data aggregation and integration hub. The hub provided the link between the calculated risk and air pollutants exposure rate for each air filter and ventilation rate conditions examined.

The data was not made available to the participants to ensure they did not make any intervention that could compromise the quality of the research. However, in situations where serious concerns were observed about the development of the foetal, due to reasons that may not be associated with the research, affected participants were informed to seek immediate medical intervention. The affected participants were taken out of the study. In that case, no news from Amira and her team to the participants was good news to the participants.

In addition to the experimental study, Amira used an AI-based simulation tool to replicate the experimental study with a larger sample size and better control of all the variables, including air pollutant source strength. The accuracy of the simulation tool was validated with measured data from the experimental study.

The simulation study examined particle filters with different CADRs (75 CFM, 100 CFM, 200 CFM, 300 CFM, and 400 CFM). In another simulation study, a particle filter with 400CFM CADR without activated carbon impregnation was impregnated with different amounts (100g, 200g, 300g, 400g, and 500g) of activated carbon impregnated in it was examined. Thus, a total of 11 groups, which include a group with no filter intervention, were studied in the simulation to answer research questions 1 and 3. 50 pregnant women were assigned to each group.

The simulation tool was so sophisticated that it could accurately simulate pregnant women and how their exposure to air pollutants influenced the risk of their poor neurodevelopment and cognitive function occurrence to their foetus. The simulation for the 11 groups was done at 5 different ventilation rates to answer research question 2.

The ventilation rates are 0.1 ACH, 0.2 ACH, 0.35 ACH, 0.5 ACH, and 0.75 ACH. The plotting was done the same way as the field experimental study, i.e., risk value on the y-axis and exposure rate on the x-axis. Lines of best fit were done to visually compare the ventilation rates. The same was done separately in comparing the particle air filter CADRs conditions and to compare different amounts of activated carbon conditions examined.

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The following were the main findings from Amira’s PhD study.

An increase in the exposure rate of the pregnant women participants increases the risk of poor neurodevelopment and cognitive function of foetus. Participants in the Control group had the highest level of exposure rate, leading to the highest risk of poor neurodevelopment and cognitive function occurrence.

Participants in the Intervention 2 group had the least exposure and the least risk. Having an intervention in one’s household, like using a particle air filter unit, especially when impregnated with activated carbon, can provide a great health benefit to indoor occupants, including pregnant women and their foetuses.

Exposure rate and risk of poor neurodevelopment and cognitive function occurrence recorded in the Control group are significantly higher (p<0.001) than those recorded in Intervention 1 and Intervention 2 groups, irrespective of the air pollutants (PAHs, PM_2.5, PM₁₀, CO₂, CO, NO₂, SO₂, O₃, and TVOCs) studied. Exposure rate and risk of poor neurodevelopment and cognitive function occurrence recorded in the Intervention 1 group are significantly higher (p<0.05) than those recorded in Intervention 2 for all air pollutants studies, except for PM_2.5 and PM₁₀.

The difference was significant for gaseous air pollutants because activated carbon impregnated in the particle air filters used in the Intervention 2 group is designed to remove gaseous air pollutants and thus has a greater removal capacity than ordinary particle air filters.

Although the difference was not significant in the case of PM_2.5 and PM₁₀, exposure rates and risk levels in the Intervention 1 group with particle air filters were noticeably higher than those in the Intervention 2 group with particle air filters impregnated with activated carbon. The observed noticeable difference was because the activated carbon primarily designed to remove gaseous air pollutants still has some particle removal capability

Out of the air pollutants studied, PM_2.5 was observed to have the highest impact on the risk of poor neurodevelopment and cognitive function occurrence than other air pollutants measured in all the 3 experimental groups. PM_2.5 had the highest impact on the foetal risk because it is small enough to penetrate deep into humans and even cross the placental barrier, potentially affecting foetal neurodevelopment and consequently compromising cognitive function.

In the experimental study, exposure rates of participants to all air pollutants studied and risk to their foetal neurodevelopment and cognitive function were lower when the ventilation rate was greater or equal to 0.35 ACH than when ventilation rates were below 0.35 ACH in all the 3 experimental groups. The difference was significant (p<0.05) in the Intervention 1 and 2 groups because of air filters adoption. The difference was noticeable in the Control group but not significant (p>0.05) because of no air filter adoption and the highly polluted outdoor air that often occurs in the country.

When adjustment was made for the days when outdoor air was polluted, and ventilation was adopted, the difference between a ventilation rate below 0.35 ACH and a ventilation rate greater or equal to 0.35 ACH in the Control group was significant in favour of the latter providing better health outcomes and reduction in exposure rate. The observed significant difference between the ventilation rates in the case of Intervention 1 and 2 groups was more, i.e., p<0.001, after the adjustment.

The lesson learnt from this observation is that polluted outdoor air compromises the benefit inherent in adopting ventilation and increasing its rate. The benefits of adopting air filters, especially those impregnated with activated carbon, will become more evident when outdoor air is polluted.

In the simulation study, the effect of adopting and increasing the ventilation rate was more evident as outdoor air was simulated to be very clean. Thus, every incremental increase in ventilation rate evidently reduced exposure to all the air pollutants studied and the risk of poor neurodevelopment and cognition function occurrence.

Unlike in the experimental study, where ventilation as a source of air pollutants competed with ventilation as a sink of air pollutants in the participants’ households, ventilation served solely as a sink (removal) of air pollutants in the households in the simulation study.

The effect of an incremental increase in the amount of activated carbon impregnated in a particle air filter evidently reduces exposure to gaseous air pollutants and the risk of poor neurodevelopment and cognitive function occurrence to their foetals.

The effect of an incremental increase in CADR of a particle air filter evidently reduced the exposure rate of the participants to PM_2.5 and PM₁₀ and the risk of poor neurodevelopment and cognitive function occurrence to their foetals. The effect of an incremental increase in the amount of gaseous removal efficiency due to an increase in the amount of activated carbon impregnated in the particle filter evidently reduced the exposure rate of the participants to the gaseous air pollutants and the risk of poor neurodevelopment and cognitive function occurrence to their foetals.

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Amid her PhD study, Amira’s innovative research sparked waves of interest in her family, in her country of residence (Mandiyun), regionally, and internationally. The reason why Amira’s research is of interest to everyone, irrespective of their expertise level, is summarised in the exchange she had with her brother, Amir.

“The placenta connecting the mother’s bloodstream to the foetal bloodstream could be infiltrated with harmful air pollutants if the mother is exposed to air pollutants. Like the movement of nutrients and other substances, air pollutants moved from the mother’s bloodstream, across the placenta, and into the foetal bloodstream.

Although the placenta has a barrier meant to protect the foetus by restricting the movement of harmful substances, some air pollutants can bypass the barrier due to their small size and solubility, gas exchange phenomenon, particle uptake by placental cells, and metabolism and detoxification. Without care, foetal bloodstream could be infiltrated with harmful air pollutants.” Amira shared this with his brother.

“OMG! So, a foetal capability of being harmed, i.e., vulnerability, will increase if the pregnant woman carrying the foetus is exposed to air pollutants, especially in indoor environments where humans are known to spend >90% of their times.” Amir said in a surprised and scared tone. “An increase in vulnerability will increase the risk of harm and damage occurring to the foetus with an increase in toxicity of air pollutants that find their way to the foetus.” Amir shared his thoughts.

“Yes, brother! That is a better way to put it. The research programme designed by my team and me helped us understand how to protect pregnant women better. A protected pregnant woman means a protected foetus. Our main research question is, how does adopting ventilation and air cleaner impact indoor air quality and reduce pregnant women’s exposure to indoor air pollutants, and what are the potential implications for foetal neurodevelopment and cognitive function?” Amira shared. Amira further shared details about their study and how the impregnation of activated carbon with particle filters could effectively protect pregnant women and their unborn children.

Amira’s groundbreaking discoveries illuminated the dire consequences of poor indoor air quality on health and unveiled its hidden role in exacerbating societal discord. The implication of Amira’s PhD findings was not limited to pregnant women and their foetuses. It has implications for the health and wellbeing of indoor occupants. Amira’s PhD findings got much publicity and increased consciousness for adopting ventilation and air filters to improve indoor air quality. The public health burden was reduced significantly as a result.

The originality and high scholarly quality of Amira’s PhD research publications propelled Amira into a coveted postdoctoral position at a prestigious university outside her Mandiyun, where she continued to unravel the complex interplay between physical wellbeing and social harmony.

Amira’s postdoc years were marked by tireless dedication. Her research ventured into uncharted territories, exposing how the discomfort caused by poor air quality catalysed negative emotions and strained relationships. This pioneering work attracted global attention and positioned her as a frontrunner in the field. It was not long before she earned a place on the faculty as an Assistant Professor of Public Health and Social Harmony at the National University of Mandiyun (NUM).

Amira got several faculty position offers due to her reputation and the quality of research work she did during her PhD and postdoc studies. However, she decided to return to Mandiyun to be close to her parents, brother, and husband, whom she married towards the end of her postdoc. Her mission of changing Mandiyun’s citizen attitude toward foreigners for the better through improvement to public health was another reason Amira returned to Mandiyun.

As Amira stepped into her role as an educator and researcher, she recognised the need to translate her findings into transformative action. Armed with her unique insights, she ignited a movement that would change lives. Her classroom became a haven for critical discussions about the profound impact of indoor air quality on behaviour and social dynamics. Students were inspired not just to pursue knowledge but to wield it as a catalyst for change.

Amira’s impact extended beyond research and academia. Her expertise became a beacon of hope for industries, communities, and public health organisations. As she rose to the rank of Associate Professor, her collaborative efforts reached new heights. She worked hand in hand with industries to implement cleaner air practices, easing the discomfort that had long fanned the flames of irrational behaviour. Her community initiatives aimed at raising awareness resonated deeply, prompting citizens to recognise the link between health and empathy.

With the honour of becoming a Full Professor, Amira’s influence radiated globally. Professor Amira Kano became a sought-after advisor for governments grappling with divisive issues. Through industry partnerships, she championed sustainable practices that alleviated physical and psychological discomfort and, in turn, alleviated societal tensions.

Her work led to tangible improvements in industry practices, resulting in cleaner air in workplaces, schools, and homes. She spearheaded community initiatives that raised awareness about indoor air quality and empowered individuals to make healthier choices. Her research was the foundation for policies that prioritised healthy indoor environments, fostering unity and understanding. Through collaborations with public health agencies, she influenced policy decisions that prioritised the well-being of citizens.

Her legacy was cemented as she became a global icon, recognised for her invaluable contributions to science, education, and public health. Her journey from a young researcher to a full-fledged visionary had not only transformed her life but also transformed the lives of countless others.

Professor Amira Kano’s story was a testament to the power of passion, perseverance, and a commitment to making a positive impact. Her journey showcased how one person’s expertise could ripple through industries, communities, and societies, leaving a legacy of healthier indoor environments, informed individuals, and a better quality of life for all.

Professor Amira Kano’s legacy was one of healing. Her journey from a researcher to a visionary not only revolutionised public health but also ushered in an era of compassion and inclusion. She dismantled the barriers of bullying, hatred, and prejudice by addressing poor public health, a root cause of the negative sentiments shown to foreigners in Mandiyun.

Professor Amira Kano’s parents were very proud of what their children had become, valued citizens of the world despite the negative sentiment directed towards their family during their children’s childhood years. Amira’s brother, Amir, became a Chief Economist at the World Bank. Through her relentless pursuit of truth and boundless empathy, Professor Amira Kano emerged as a beacon of change—a living testament to the power of science to mend hearts and bridge divides. Professor Amira Kano and her husband, Barrister Yusuf Kaduna, Senior Counsel of Mandiyun (SAM), had Triplets who excelled in their studies. The End!