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Objectives: An increasing number of countries are banning the production and use of asbestos, in compliance with the ratification of the C162 Asbestos Convention and the Basel Convention, and in response to the call for its elimination in the ILO resolution and WHO reports on the health risks associated with asbestos. Nevertheless, several countries, including Kyrgyzstan, are still miners and/or manufacturers of asbestos. The main objective of the study is to assess the occupational exposure to chrysotile of workers engaged in a production facility of asbestos-cement products in Kyrgyzstan., Methods: Monitored workers (n = 16, for a total of n = 18 samples) were divided into 3 "Similar Exposure Groups" (SEGs; SEG-1: asbestos loading; SEG-2; asbestos-cement mixing; SEG-3: cutting of asbestos-cement sheets) according to EN 689 standard. Samples were collected through personal sampling and subsequently examined by means of scanning electron microscope equipped with an energy-dispersive spectrometer for the compositional analysis of each fibre. The numerical concentration of airborne asbestos fibres was henceforward determined by dividing the number of fibres and the volume of sampled air (expressed in the number of fibres per millilitre of air: ff/ml)., Results: Investigated workers resulted to be exposed to chrysotile fibres. Results (GM ± GSD) outlined extremely high exposure levels for SEG-1 (2.2 ± 2.1 ff/ml) and SEG-3 (4.7 ± 1.6 ff/ml) workers and lower-but still relevant-exposure values for SEG-2 (0.91 ± 2.6 ff/ml) workers., Conclusions: The results obtained in this case study can help to document potentially critical situations of occupational exposure to asbestos that can still occur nowadays in low and middle-income countries where asbestos is still mined and processed., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach., Materials and Methods: Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups., Results: Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: + 32.9 % ), followed by Postural control (step width: + 27.0 % ), Phases (stance time: + 11.0 % ), and Pace (stride length: -  9.3 % ). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001)., Conclusions: This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains., (© 2024. The Author(s).)

Short-term exposure to fine particulate matter (PM 2.5 ) is associated with the activation of adverse inflammatory responses, increasing the risk of developing acute respiratory diseases, such as those caused by pathogen infections. However, the functional mechanisms underlying this evidence remain unclear. In the present study, we generated a zebrafish model of short-term exposure to a specific PM 2.5 , collected in the northern metropolitan area of Milan, Italy. First, we assessed the immunomodulatory effects of short-term PM 2.5 exposure and observed that it elicited pro-inflammatory effects by inducing the expression of cytokines and triggering hyper-activation of both neutrophil and macrophage cell populations. Moreover, we examined the impact of a secondary infectious pro-inflammatory stimulus induced through the injection of Pseudomonas aeruginosa lipopolysaccharide (Pa-LPS) molecules after exposure to short-term PM 2.5 . In this model, we demonstrated that the innate immune response was less responsive to a second pro-inflammatory infectious stimulus. Indeed, larvae exhibited dampened leukocyte activation and impaired production of reactive oxygen species. The obtained results indicate that short-term PM 2.5 exposure alters the immune microenvironment and affects the inflammatory processes, thus potentially weakening the resistance to pathogen infections., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Several studies have demonstrated the effectiveness of telerehabilitation. However, it remains unclear what proportion of people in need of rehabilitation can confidently use telecommunications networks and related devices., Objectives: The aim of this study is to estimate the proportion of patients who possess either the requisite digital literacy to perform telerehabilitation independently or have a family caregiver capable of providing effective support., Methods: Synthetic populations with a realistic kinship network (i.e. family trees) representative of European countries are built. Age, sex, and location-specific prevalence rates of rehabilitation needs and digital skills are combined to estimate the percentage of digitally literate patients and patients with digitally literate relatives., Results: In Europe, 86% of people in need of rehabilitation are potentially eligible for telerehabilitation. However, in four out of five cases, eligible patients over the age of 65 require caregiver support., Conclusion: Telerehabilitation has the potential to spread in Europe. Caregivers have an essential social role in ensuring sustainable access to telerehabilitation.

Several antiblastic drugs (ADs) are classified as carcinogenic, mutagenic, and/or toxic for reproduction. Despite established guidelines and safe handling technologies, ADs contamination of the work environments could occur in healthcare settings, leading to potential exposure of healthcare staff. This systematic review aims to investigate the main techniques and practices for assessing ADs occupational exposure in healthcare settings. The reviewed studies unveil that workplace contamination by ADs appears to be a still-topical problem in healthcare settings. These issues are linked to difficulties in guaranteeing: (i) the adherence to standardized protocols when dealing with ADs, (ii) the effective use of personal protective equipment by operators involved in the administration or management of ADs, (iii) a comprehensive training of the healthcare personnel, and (iv) a thorough health surveillance of exposed workers. A "multi-parametric" approach emerges as a desirable strategy for exposure assessment. In parallel, exposure assessment should coincide with the introduction of novel technologies aimed at minimizing exposure (i.e., risk management). Assessment must consider various departments and health operators susceptible to ADs contamination, with a focus extended beyond worst-case scenarios, also considering activities like surface cleaning and logistical tasks related to ADs management. A comprehensive approach in ADs risk assessment enables the evaluation of distinct substance behaviors and subsequent exposure routes, affording a more holistic understanding of potential risks.

Objectives: The quantitative job-exposure matrix SYN-JEM consists of various dimensions: job-specific estimates, region-specific estimates, and prior expert ratings of jobs by the semi-quantitative DOM-JEM. We analyzed the effect of different JEM dimensions on the exposure-response relationships between occupational silica exposure and lung cancer risk to investigate how these variations influence estimates of exposure by a quantitative JEM and associated health endpoints., Methods: Using SYN-JEM, and alternative SYN-JEM specifications with varying dimensions included, cumulative silica exposure estimates were assigned to 16 901 lung cancer cases and 20 965 controls pooled from 14 international community-based case-control studies. Exposure-response relationships based on SYN-JEM and alternative SYN-JEM specifications were analyzed using regression analyses (by quartiles and log-transformed continuous silica exposure) and generalized additive models (GAM), adjusted for age, sex, study, cigarette pack-years, time since quitting smoking, and ever employment in occupations with established lung cancer risk., Results: SYN-JEM and alternative specifications generated overall elevated and similar lung cancer odds ratios ranging from 1.13 (1st quartile) to 1.50 (4th quartile). In the categorical and log-linear analyses SYN-JEM with all dimensions included yielded the best model fit, and exclusion of job-specific estimates from SYN-JEM yielded the poorest model fit. Additionally, GAM showed the poorest model fit when excluding job-specific estimates., Conclusion: The established exposure-response relationship between occupational silica exposure and lung cancer was marginally influenced by varying the dimensions of SYN-JEM. Optimized modelling of exposure-response relationships will be obtained when incorporating all relevant dimensions, namely prior rating, job, time, and region. Quantitative job-specific estimates appeared to be the most prominent dimension for this general population JEM.

This study aimed to assess the performance, in terms of precision and accuracy, of a prototype (called "P.ALP"-Ph.D. Air Quality Low-cost Project) developed for monitoring PM 2.5 concentration levels. Four prototypes were co-located with reference instrumentation in four different microenvironments simulating real-world and working conditions, namely (i) office, (ii) home, (iii) outdoor, and (iv) occupational environments. The devices were evaluated for a total of 20 monitoring days (approximately 168 h) under a wide range of PM 2.5 concentrations. The performances of the prototypes (based on the light-scattering working principle) were tested through different statistical methods. After the data acquisition and data cleaning processes, a linear regression analysis was performed to assess the precision (by comparing all possible pairs of devices) and the accuracy (by comparing the prototypes against the reference instrumentation) of the P.ALP. Moreover, the United States Environmental Protection Agency (US EPA) criteria were applied to assess the possible usage of this instrumentation, and to evaluate the eventual error trends of the P.ALP in the data storage process, Bland-Altman plots were also adopted. The outcomes of this study underlined that the P.ALP performed differently depending on the microenvironment in which it was tested and, consequently, on the PM 2.5 concentrations. The device can monitor PM 2.5 variations with acceptable results, but the performance cannot be considered satisfactory at extremely low and remarkably high PM 2.5 concentrations. Thanks to modular components and open-source software, the tested device has the potential to be customized and adapted to better fit specific study design needs, but it must be implemented with ad hoc calibration factors depending on the application before being used in field.

Glioblastoma, IDH-wild type, CNS WHO grade 4 (GBM) is a primary brain tumor associated with poor patient survival despite aggressive treatment. Developing realistic ex vivo models remain challenging. Patient-derived 3-dimensional organoid (PDO) models offer innovative platforms that capture the phenotypic and molecular heterogeneity of GBM, while preserving key characteristics of the original tumors. However, manual dissection for PDO generation is time-consuming, expensive and can result in a number of irregular and unevenly sized PDOs. This study presents an innovative method for PDO production using an automated tissue chopper. Tumor samples from four GBM and one astrocytoma, IDH-mutant, CNS WHO grade 2 patients were processed manually as well as using the tissue chopper. In the manual approach, the tumor material was dissected using scalpels under microscopic control, while the tissue chopper was employed at three different angles. Following culture on an orbital shaker at 37 °C, morphological changes were evaluated using bright field microscopy, while proliferation (Ki67) and apoptosis (CC3) were assessed by immunofluorescence after 6 weeks. The tissue chopper method reduced almost 70% of the manufacturing time and resulted in a significantly higher PDOs mean count compared to the manually processed tissue from the second week onwards (week 2: 801 vs. 601, P = 0.018; week 3: 1105 vs. 771, P = 0.032; and week 4:1195 vs. 784, P < 0.01). Quality assessment revealed similar rates of tumor-cell apoptosis and proliferation for both manufacturing methods. Therefore, the automated tissue chopper method offers a more efficient approach in terms of time and PDO yield. This method holds promise for drug- or immunotherapy-screening of GBM patients.

This Analysis presents a recently developed food system indicator framework and holistic monitoring architecture to track food system transformation towards global development, health and sustainability goals. Five themes are considered: (1) diets, nutrition and health; (2) environment, natural resources and production; (3) livelihoods, poverty and equity; (4) governance; and (5) resilience. Each theme is divided into three to five indicator domains, and indicators were selected to reflect each domain through a consultative process. In total, 50 indicators were selected, with at least one indicator available for every domain. Harmonized data of these 50 indicators provide a baseline assessment of the world's food systems. We show that every country can claim positive outcomes in some parts of food systems, but none are among the highest ranked across all domains. Furthermore, some indicators are independent of national income, and each highlights a specific aspiration for healthy, sustainable and just food systems. The Food Systems Countdown Initiative will track food systems annually to 2030, amending the framework as new indicators or better data emerge., (© 2023. The Author(s).)

Background: Rehabilitation plays a key role in the recovery of upper extremity function after breast cancer surgery. Motion capture (mocap) systems for serious gaming have shown the potential to enable home-based rehabilitation, but clinical accuracy needs to be examined., Objectives: Validation of markerless mocap systems for telerehabilitation after breast cancer surgical intervention., Methods: The accuracy of the markerless mocap device Azure Kinect in detecting compensatory movements and postural disturbances has been compared to a gold standard Optitrack system in five volunteers. Subsequently, a serious game for mocap-based shoulder exercises has been developed and integrated into a telerehabilitation platform., Results: The Azure Kinect shows good reliability for scapular elevation (ICC >0.80; MAE <2.1 cm) and trunk tilt (ICC=0.88; MAE=5°), moderate reliability for rounded shoulders (ICC=0.51; MAE=2.6cm) and poor reliability for kyphosis angle (ICC=0.22; MAE=18°)., Conclusion: The Azure Kinect provides reasonable performance for shoulder rehabilitation. The proposed telerehabilitation platform has been tested by rehabilitation specialists and received positive feedback.

Although the Covid-19 pandemic is still ongoing, the environmental factors beyond virus transmission are only partially known. This statistical study has the aim to identify the key factors that have affected the virus spread during the early phase of pandemic in Italy, among a wide set of potential determinants concerning demographics, environmental pollution and climate. Because of its heterogeneity in pollution levels and climate conditions, Italy provides an ideal scenario for an ecological study. Moreover, the selected period excludes important confounding factors, as different virus variants, restriction policies or vaccines. The short-term relationship between the infection maximum increase and demographic, pollution and meteo-climatic parameters was investigated, including both winter-spring and summer 2020 data, also focusing separately on the two seasonal periods and on North vs Centre-South. Among main results, the importance of population size confirmed social distancing as a key management option. The pollution hazardous role undoubtedly emerged, as NO 2 affected infection increase in all the studied scenarios, PM 2.5 manifested its impact in North of Italy, while O 3 always showed a protective action. Whereas higher temperatures were beneficial, especially in the cold season with also wind and relative humidity, solar irradiance was always relevant, revealing several significant interactions with other co-factors. Presented findings address the importance of the environment in Sars-CoV-2 spread and indicated that special carefulness should be taken in crowded areas, especially if they are highly polluted and weakly exposed to sun. The results suggest that containment of future epidemics similar to Covid-19 could be supported by reducing environmental pollution, achieving safer social habits and promoting preventive health care for better immune system response, as an only comprehensive strategy., Competing Interests: The authors declare no conflict of interest., (© 2023 Published by Elsevier Ltd.)

Background: One of the longest-standing treatments to prevent delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains raising the blood pressure to a certain level of mean arterial pressure. This may require high doses of norepinephrine, which has been associated with severe end organ damage. With this study, we aimed to investigate the effects of norepinephrine on the incidence of DCI in a clinical setting., Methods: We conducted a retrospective evaluation of patients with aSAH admitted to our institution between November 2018 and March 2021. Potential risk factors for DCI were analyzed and significant predictors were assessed by means of a logistic regression analysis to account for potential confounders., Results: In this study, 104 patients were included. Hereof, 39 (38%) showed radiologic signs of DCI between day three and 14 post-intervention. These patients had more frequent vasospasms (n = 37 vs. 30, p = 0.022), a higher Hunt & Hess score (3 ± 2 vs. 2 ± 1, p = 0.004), a lower initial Glasgow Coma Scale score (9 ± 5 vs. 12 ± 4, p = 0.003) and received a higher median norepinephrine dose (20,356μg vs. 6,508μg, p < 0.001). A logistic regression analysis revealed that only high-dose norepinephrine administration (OR 2.84, CI 1.56-7.8) and vasospasm (OR 3.07, CI 1.2-7.84) appeared to be significant independent risk factors for DCI., Conclusion: Our results indicate a significant association between higher dose norepinephrine administration and the occurrence of DCI. Future research including greater sample sizes and a prospective setting will be necessary to further investigate the relationship., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cattaneo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective During the induction of gaseous anaesthesia, waste anaesthetic gases (WAGs) can be released into workplace air. Occupational exposure to high levels of halogenated WAGs may lead to adverse health effects; hence, it is important to measure WAGs concentration levels to perform risk assessment and for health protection purposes. Methods A systematic review of the scientific literature was conducted on two different scientific databases (Scopus and PubMed). A total of 101 studies, focused on sevoflurane, desflurane and isoflurane exposures in hospitals, were included in this review. Key information was extracted to provide (1) a description of the study designs (e.g., monitoring methods, investigated occupational settings, anaesthetic gases in use); (2) an evaluation of time trends in the measured concentrations of considered WAGs; (3) a critical evaluation of the sampling strategies, monitoring methods and instruments used. Results Environmental monitoring was prevalent (68%) and mainly used for occupational exposure assessment during adult anaesthesia (84% of cases). Real-time techniques such as photoacoustic spectroscopy and infrared spectrophotometry were used in 58% of the studies, while off-line approaches such as active or passive sampling followed by GC-MS analysis were used less frequently (39%). Conclusions The combination of different instrumental techniques allowing the collection of data with different time resolutions was quite scarce (3%) despite the fact that this would give the opportunity to obtain reliable data for testing the compliance with 8 h occupational exposure limit values and at the same time to evaluate short-term exposures.

Introduction: Literature suggests that patient engagement in healthy lifestyle is of crucial importance in ensuring a more effective management of side effects of cancer therapies and better quality of life for patients. While many studies describe educational interventions to promote healthy lifestyles, few are focused on promoting active patient engagement in this field. This protocol paper outlines a study to determine the feasibility of a complex nurse-led patient education intervention aimed to promote cancer patient engagement in a healthy lifestyle., Method and Analysis: This is a randomised pilot and feasibility study. Research nurses will recruit 40 adult patients newly diagnosed with cancer. Consenting participants will be randomised to undergo the patient engagement in healthy lifestyle intervention or the control group by means of a four-block randomisation procedure. The intervention will be delivered by a clinical nurse trained in patient engagement strategies. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include changes between and within groups in healthy lifestyle behaviours (ie, increase in healthy diet, smoke cessation or reduction, increase in physical activity), in quality-of-life rates after the intervention, in patient engagement levels, in the perception of the quality of care, in nutritional status; the number of recurrences or the onset of new cancer diagnosis; the number of hospitalization., Ethics and Dissemination: The study protocol has been approved by the Canton Ticino Ethical Committee (Protocol ID: 2020-02477 TI). The results will be published in peer-reviewed journals and will be presented at national and international congresses. Finally, patients' organisations, such as the Swiss Cancer League, will be involved in the dissemination process. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The goals of this work are the evaluation of the performances of official methods in the challenging determination of Cr(VI) in Cr(III)-rich particulate matter, and the development of a novel and robust analytical protocol for this issue. A liquid chromatography inductively coupled plasma mass spectrometry apparatus (LC-ICP-MS), together with an isotope-enriched spike addition technique, was used to allow the study of Cr(III)/Cr(VI) interconversions during the extraction step. An original separation strategy based on Cr(OH) 3 head-column stacking was developed to tolerate high concentrations of Cr(III) (up to 10 mg/kg, with a Cr(VI) limit of detection of 0.51 µg/kg) without the need of any sample pretreatment. After observing, the official extraction protocols always yield false positive values in the challenging situation of particulate matter of leather industries (where huge amounts of Cr(III) are present), a new extraction strategy was developed. The novel procedure involves a 48-h extraction at room temperature using a pH-8 phosphate buffer, which demonstrated that no Cr(III)/Cr(VI) interconversions occur during this phase. To get rid of any possible interference caused by co-extracted substances, the measurement of the redox potential, together with the addition of a Fe(II)/Fe(III) redox buffer was performed to fix chromium speciation during the overall analytical protocol.

The biogenic synthesis of nanomaterials, i.e., synthesis carried out by means of living organisms, is an emerging technique in nanotechnology since it represents a greener and more eco-friendly method for the production of nanomaterials. In this line, in order to find new biological entities capable of biogenic synthesis, we tested the ability of some extremophilic microorganisms to carry out the biogenic production of AgNPs and SeNPs. Silver NPs were produced extracellularly by means of the thermophilic Thermus thermophilus strain SAMU; the haloalkaliphilic Halomonas campaniensis strain 5AG was instead found to be useful for the synthesis of SeNPs. The structural characterization of the biogenic nanoparticles showed that both the Ag and Se NPs possessed a protein coating on their surface and that they were organized in aggregates. Moreover, both types of NPs were found be able to exert an interesting antibacterial effect against either Gram-positive or Gram-negative species. This study confirmed that extremophilic microorganisms can be considered valuable producers of biologically active nanoparticles; nevertheless, further experiments must be performed to improve the synthesis protocols in addition to the downstream processes.

Refineries are characterized by relevant odour impacts, and the control and monitoring of this pollutant have become increasingly important. Dynamic olfactometry, a sensorial analysis that involves human examiners, is currently the most common technique to obtain odour quantification. However, due to the potential presence of hazardous pollutants, the conduction of occupational risk assessment is necessary to guarantee examiners' safety. Nevertheless, the occupational risk for olfactometric examiners, specifically correlated with oil refineries emissions, has not been investigated yet. Therefore, this paper applies a new methodology of risk assessment for workers involved in dynamic olfactometry, focusing on odorous refineries emissions. The chemical characterization of refinery emissions was obtained by TD-GC-MS, analysing odorous samples collected at different refinery odour sources. A database of chemical pollutants emitted from a refinery plant was built up, and the minimum dilution values to be adopted during the analysis of refinery odorous samples was calculated. In particular, this evaluation highlighted that, in this scenario, a non-negligible carcinogenic risk may exist for panellists exposed to refineries' samples, and the carcinogenic risk is sometimes higher than what is acceptable. Therefore, a minimum dilution value between 1.01 and 5, according to the specific sample, must be set to guarantee the examiners' safety.

The PRIMATE study is an Italian translational research project, which aims to identify personalized biomarkers associated with clinical characteristics of malignant pleural mesothelioma (MPM). For this purpose, characteristics of MPM patients with different degrees of asbestos exposure will be compared to identify somatic mutations, germline polymorphism, and blood inflammatory biomarkers. In this framework, we assessed exposure to asbestos for 562 cases of MPM extracted from the Lombardy region Mesothelioma Registry (RML), for which a complete interview based on a standardized national questionnaire and histopathological specimens were available. Exposure assessment was performed: (1) through experts' evaluation (considered as the gold standard for the purpose of this study), according to the guidelines of the Italian National Mesothelioma Registry (ReNaM) and (2) using a job-exposure matrix (SYN-JEM) to obtain qualitative (ever/never) and quantitative estimates of occupational asbestos exposure (cumulative exposure expressed in fibers per mL (f/mL)). The performance of SYN-JEM was evaluated against the experts' evaluation. According to experts' evaluation, occupational asbestos exposure was recognized in 73.6% of men and 23.6% of women; furthermore, 29 men (7.8%) and 70 women (36.9%) had non-occupational exposure to asbestos. When applying SYN-JEM, 225 men (60.5%) and 25 women (13.2%) were classified as occupationally exposed, with a median cumulative exposure higher for men (1.7 f/mL-years) than for women (1.2 f/mL-years). The concordance between the two methods (Cohen's kappa) for occupational exposure assessment was 0.46 overall (0.41 in men, and 0.07 in women). Sensitivity was higher in men (0.73) than in women (0.18), while specificity was higher in women (0.88) than in men (0.74). Overall, both methods can be used to reconstruct past occupational exposure to asbestos, each with its own advantages and limitations.

Background: Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures., Methods: 6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems ("skin-to-skin" and "OR entry to exit")., Results: The procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5-6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions., Conclusion: The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.

Using travel time to cities of different sizes, we map populations across an urban-rural continuum to improve on the standard dichotomous representations of urban-rural interactions. We extend existing approaches by 1) building on central place theory to capture the urban hierarchy in access to services and employment opportunities provided by urban centers of different sizes, 2) defining urban-rural catchment areas (URCAs) expressing the interconnection between urban centers and their surrounding rural areas, and 3) adopting a global gridded approach comparable across countries. We find that one-fourth of the global population lives in periurban areas of intermediate and smaller cities and towns, which challenges the centrality of large cities in development. In low-income countries, 64% of the population lives either in small cities and towns or within their catchment areas, which has major implications for access to services and employment opportunities. Intermediate and small cities appear to provide catchment areas for proportionately more people gravitating around them than larger cities. This could indicate that, for countries transitioning to middle income, policies and investments strengthening economic linkages between urban centers and their surrounding rural areas may be as important as investing in urbanization or the rural hinterlands. The dataset provided can support national economic planning and territorial development strategies by enabling policy makers to focus more in depth on urban-rural interactions., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

Hypertensive disorders are common complications during pregnancy (HDP) with substantial public health impact. Acute and chronic particulate matter (PM) exposure during pregnancy increases the risk of HDP, although the underlying molecular mechanisms remain unclear. Extracellular vesicles (EVs) may be the ideal candidates for mediating the effects of PM exposure in pregnancy as they are released in response to environmental stimuli. The INSIDE project aims to investigate this mechanism in pregnancy outcomes. The study population is enrolled at the Fetal Medicine Unit of Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico at 10-14 weeks of gestation. Exposure to PM 10 and PM 2.5 is assessed using the flexible air quality regional model (FARM) and Bayesian geostatistical models. Each woman provides a blood sample for EV analysis and circulating biomarker assessment. Moreover, a subgroup of recruited women (n = 85) is asked to participate in a cardiovascular screening program including a standard clinical evaluation, a non-invasive assessment of right ventricular function, and pulmonary circulation at rest and during exercise. These subjects are also asked to wear a personal particulate sampler, to measure PM 10 , PM 2.5 , and PM 1 . The INSIDE study is expected to identify the health impacts of PM exposure on pregnancy outcomes.

The number of people infected with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), i.e. the virus causing coronavirus disease (COVID-19), is dramatically increasing worldwide to the size of a pandemic. At the time of writing Italy is ranking first among countries both in terms of number of COVID-19 confirmed cases and in terms of number of deaths. Such a wide spread of COVID-19 has led to concern among workers who are facing the risk of becoming infected during the execution of their duties. We believe it is useful to remark on the need for professional expertise in the field of Occupational Hygiene in this emergency context, in which the indications provided by national and international bodies, the available scientific literature and the legal provisions are constantly and rapidly evolving. It is of fundamental importance that there is an effective analysis of expert inputs, to provide essential guidance to Health, Safety and Environmental managers and other prevention managers in workplaces. In this regard, not only a constant update of the regulatory framework is needed, but also a development and circulation of operational guidance to all the stakeholders to translate general indications into clear operating procedures and implementation tools to be adopted in the workplaces. We believe that the scientific associations in the field of Occupational Hygiene play a crucial role in guiding and assisting prevention professionals. There is considerable expertise in the occupational hygiene and exposure science communities that can help employers and workers to contain and delay the spread of COVID-19. For this reason, the Italian Association of Industrial Hygienists (AIDII-Associazione Italiana degli Igienisti Industriali) published documents containing operational guidelines to provide correct and constantly updated information for: (i) workers employed in essential activities (with low and medium risk of contagion), (ii) health workers and other workers at high or very high risk of contagion, and (iii) for the correct use and handling of personal protective equipment for workers and for the population in general. It is worth pointing out that the documents produced are not intended to replace those produced by authoritative bodies, but to comply with and complete them by reporting an effective summary and further indications about the measures that should be taken in practice under the light of the Italian legislation. At present, the challenge is to produce scientifically sound knowledge, appropriate tools, and effective methodologies, by coordinating the initiatives of different scientific associations, with the final aim to effectively transfer them to employers and workers., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

In 1969, the Italian Association of Industrial Hygienists (AIDII) was founded in Milan by Academics working at the Clinica del Lavoro, one of the oldest institutions for work prevention in the world and within the most prolific institutes in the world on Occupational Medicine and Industrial Hygiene. AIDII was founded as a scientific association with the primary purpose of promoting the development, deepening and dissemination of Industrial Hygiene, the scientific discipline aimed at identifying, assessing and controlling chemical, physical and biological risk factors (as well as transversal risks) either inside or outside the workplace, which can alter the health and wellbeing status of workers and/or the general population, for the purpose of effective prevention and protection of human health. Over the decades, the activities of AIDII have evolved to meet some of the current needs and challenges, while remaining consistent with the basics set by the founders.

Summary: Research laboratories represent peculiar employment realities, generally characterized by the use of reduced volumes of several chemicals, often used in mixture, thus defining a potential exposure to multiple chemical agents. Methods. The aim of the study is to provide a brief review of the most widely used methods for assessing chemical risk in laboratories, with particular emphasis on their limits and advantages. Results. The approach most often used for assessing chemical risk in research laboratories involves the use of a qualitative modeling approach for risk assessment or quantitative exposure assessment tools. Conclusions. Chemical risk assessment algorithms represent a useful solution for the purposes of the initial screening for the assessment of chemical risk in research laboratories: their ease of use makes them easily accessible, but on the other hand does not allow to take into proper consideration the particularities of the assessed exposure scenarios. Regarding the exposure estimation models, although these instruments have a wide range of applicability, there is no solid and complete validation, which evaluates the accuracy and reliability for this peculiar type of exposure scenarios., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by Aracne Editrice, Roma, Italy.)

Airborne particulate matter (PM) concentrations inside vehicle cabins are often extremely high compared to background levels. The present study was motivated by the fact that in the last few decades, the implementation of new emission standards has led to the reduction of vehicle particle emissions. This study addresses for the first time the relationship between leading vehicle (LV) emissions and in-cabin PM exposure levels in the immediately following vehicle (henceforth called the study vehicle - SV), with particular emphasis on the role of the LV's emission reduction technologies (e.g., diesel particulate filter-DPF) as an effective risk management measure. The study was performed using an instrumented study vehicle (always to be considered as the following vehicle) on a 26-km fixed route where 10 repeated tests were conducted during 60-minute trips. On-line monitoring of the fine 0.3-1 μm and 1-2.5 μm (PM 0.3-1 and PM 1-2.5 ) and ultra-fine particle (UFP) concentrations was performed inside the SV's car cabin with fixed ventilation settings (i.e., windows closed, air conditioning off, and recirculation fan off). Simultaneously, the license plate numbers of the LVs along the route were recorded to retrieve information pertaining to their fuel type and Euro emission standard category. The results clearly showed that the in-cabin PM levels were significantly affected by the LV's Euro emission standard. Regarding petrol-fuelled LVs, the median in-cabin particle exposure levels were statistically lower (e.g., -34% for PM 0.3-1 ) when following vehicles with stricter emission standards (in particular, Euro 6) than when following a low-emission standard vehicle (i.e., Euro 0-2). Concerning diesel-fuelled LVs, a strong and significant decrease in the in-cabin median exposure levels (up to -62%, -44%, and -48% for UFPs, PM 0.3-1 , and PM 1-2.5 , respectively) was observed for recent-emission standards LVs (i.e., Euro 5-6) with respect to older-emission standard LVs (i.e., Euro 0-4). A specific analysis revealed that the in-cabin median exposure concentrations of PM were highly and significantly reduced by DPF-equipped LVs. For UFPs, this resulted in a 47% reduction compared to diesel-fuelled (non-DPF) LVs. For PM 0.3-1 , an approximate 80% reduction was observed compared to both petrol-fuelled and diesel-fuelled (non-DPF) LVs. For PM 1-2.5 , an approximate 38% reduction was observed compared to petrol-fuelled LVs and a 46% reduction compared to non-DPF LVs., (Copyright © 2019. Published by Elsevier Ltd.)

An experimental probabilistic approach for health risk assessment was applied for graphene nanoplatelets (GNPs). The hazard assessment indicated a low level of toxicity for the GNPs. The benchmark dose method, based on sub-chronic and chronic inhalation exposure studies, was used to quantify a guidance value (BMC h ) for occupational inhalation exposure to GNPs, expressed as a lognormal distribution with a geometric mean ± geometric standard deviation of 0.212 ± 7.79 mg/m 3 and 9.37 × 10 4  ± 7.6 particle/cm 3 . Exposure scenarios (ES) were defined based on the scientific literature for large-scale production (ES1) and manufacturing (ES2) of GNPs; a third ES, concerning in-lab handling of GNPs (ES3) was based on results of experiments performed for this study. A probability distribution function was then assumed for each ES. The risk magnitude was calculated using a risk characterization ratio (RCR), defined as the ratio of the exposure distributions and the BMC h distribution. All three ES resulted in RCR distributions ≥1 (i.e. risk present); however, none of the ES had a statistically significant level of risk at a 95% confidence interval. A sensitivity analysis indicated that ∼75% of the variation in the RCR distributions was due to uncertainties in the BMC h calculation., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Background: Human polyomaviruses (HPyVs) asymptomatically infect the human population during childhood and establish latency in the host. Viral reactivation and urinary excretion can occur when the immune system is impaired. Exposure to particulate air pollution, including the PM 10 /PM 2.5 components, is a public health problem and has been linked to several disorders. Studies assessing the relationship between PM 10 /PM 2.5 exposure and viral replication are lacking., Objectives: To investigate the relationship between HPyVs viruria and PM 10 /PM 2.5 exposures., Methods: Individual environmental exposure was assessed in 50 healthy adult volunteers using a chemical transport model (CTM) with a municipality resolution for daily PM 10 and monitoring stations data for daily PM 2.5 exposures. For each subject, a urine sample was collected, and HPyVs (JCPyV, BKPyV, MCPyV, HPyV6, HPyV7 and HPyV9) loads were determined. Zero-inflated negative binomial (ZINB) regression was used to model the count data, as it contained excessive zeros. Covariates were chosen by stepwise selection., Results: HPyVs DNA was detected in 54% (median:87.6*10 5 copies/ml) of the urine samples. JCPyV was the prevalent (48%, (median viral load:126*10 5 copies/ml). Considering the load of the most frequently measured HPyVs, JCPyV, in the count-part of the ZINB model, every unitary in PM measured 2 days before urine collection (PM Day -2) was associated with an increase in JCPyV load (PM 10 : +4.0%, p-value = 0.002; PM 2.5 : +3.6%, p-value = 0.005). In the zero-part, the significant predictor was the PM 10 measured 5 days before urine collection (+3%, p-value = 0.03)., Conclusions: The environmental levels of PM 10 /PM 2.5 increase the JCPyV viruria. Our findings emphasize the need for studies assessing the influence of air pollution exposure on the risk of viral reactivation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate the precision, accuracy, practicality, and potential uses of a PM 2.5 miniaturized monitor (MM) in exposure assessment. These monitors (AirBeam, HabitatMap) were compared with the widely used direct-reading particulate matter monitors and a gravimetric reference method for PM 2.5 . Instruments were tested during 20 monitoring sessions that were subdivided in two different seasons to evaluate the performance of sensors across various environmental and meteorological conditions. Measurements were performed at an urban background site in Como, Italy. To evaluate the performance of the instruments, different analyses were conducted on 8-h averaged PM 2.5 concentrations for comparison between direct-reading monitors and the gravimetric method, and minute-averaged data for comparison between the direct-reading instruments. A linear regression analysis was performed to evaluate whether the two measurement methods, when compared, could be considered comparable and/or mutually predictive. Further, Bland-Altman plots were used to determine whether the methods were characterized by specific biases. Finally, the correlations between the error associated with the direct-reading instruments and the meteorological parameters acquired at the sampling point were investigated. Principal results show a moderate degree of agreement between MMs and the reference method and a bias that increased with an increase in PM 2.5 concentrations.

Background: It is recognized that engineering control measures are needed to reduce occupational exposure to engineered nanomaterials (NMs): of these, fume hoods are among the most widespread collective protection equipment used while handling NMs in occupational settings.  It is known that in some circumstances, handling NMs in fume hoods can result in a significant release of NMs., Objective: To assess the effectiveness of fume hoods in reducing exposure while handling graphene nanoplatelets and to define the conditions that result in a lower dispersion of particles and thus less operator exposure., Methods: An experimental protocol was established to monitor the variations of airborne particle concentrations while handling graphene in fume hoods (transferring and pouring). The measurement locations were at the laboratory, inside the hood and at operator's breathing zone. Handling tasks were performed under different operating conditions: the variable factors included hood face velocity and sash height., Results: Results of this study indicate that the handling of graphene nanoplatelets may pose a potential risk of contamination of the work environment and hence exposure of the involved operators, if adequate control measures are not taken. In fact, when inadequate or not sufficiently cautionary operational conditions were utilized, non-negligible increases in airborne graphene particle concentrations during the nanomaterial manipulation phases were observed., Conclusions: Some operating conditions (e.g., face velocity, sash height) can be adjusted to avoid relevant personal exposure conditions and contamination of the work environment by NMs, thus ensuring safer conditions.

Substantial efforts have been made in recent years to investigate the horizontal variability of air pollutants at regional and urban scales and epidemiological studies have taken advantage of resulting improvements in exposure assessment. On the contrary, only a few studies have investigated the vertical variability and their results are not consistent. In this study, a field experiment has been conducted to evaluate the variation of concentrations of different particle metrics and gaseous pollutants on the basis of floor height at a high rise building. Two 15-day monitoring campaigns were conducted in the urban area of Bologna, Northern Italy, one of the most polluted areas in Europe. Measurements sites were operated simultaneously at 2, 15, 26, 44 and 65 m a.g.l. Several particulate matter metrics including PM 2.5 mass and chemical composition, particle number concentration and size distribution were measured. Time integrated measurement of NO 2 and BTEX were also included in the monitoring campaigns. Measurements showed relevant vertical gradients for most traffic related pollutants. A monotonic gradient of PM 2.5 was found with ground-to-top differences of 4% during the warm period and 11% during the cold period. Larger gradients were found for UFP (∼30% during both seasons) with a substantial loss of particles from ground to top in the sub-50 nm size range. The largest drops in concentrations for chemical components were found for Elemental Carbon (-27%), iron (-11%) and tin (-36%) during winter. The ground-to-top decline of concentrations for NO 2 and benzene during winter was equal to 74% and 35%, respectively. In conclusion, our findings emphasize the need to include vertical variations of urban air pollutants when evaluating population exposure and associated health effects, especially in relation to some traffic related pollutants and particle metrics., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Exposure to particulate matter (PM) is associated with increased incidence of cardiovascular disease and increased coagulation, but the molecular mechanisms underlying these associations remain unknown. Obesity may increase susceptibility to the adverse effects of PM exposure, exacerbating the effects on cardiovascular diseases. Extracellular vesicles (EVs), which travel in body fluids and transfer microRNAs (miRNAs) between tissues, might play an important role in PM-induced cardiovascular risk. We sought to determine whether the levels of PM with an aerodynamic diameter ≤ 10 μm (PM 10 ) are associated with changes in fibrinogen levels, EV release, and the miRNA content of EVs (EV-miRNAs), investigating 1630 overweight/obese subjects from the SPHERE Study., Results: Short-term exposure to PM 10 (Day before blood drawing) was associated with an increased release of EVs quantified by nanoparticle tracking analysis, especially EVs derived from monocyte/macrophage components (CD14+) and platelets (CD61+) which were characterized by flow cytometry. We first profiled miRNAs of 883 subjects by the QuantStudio™ 12 K Flex Real Time PCR System and the top 40 EV-miRNAs were validated through custom miRNA plates. Nine EV-miRNAs (let-7c-5p; miR-106a-5p; miR-143-3p; miR-185-5p; miR-218-5p; miR-331-3p; miR-642-5p; miR-652-3p; miR-99b-5p) were downregulated in response to PM 10 exposure and exhibited putative roles in cardiovascular disease, as highlighted by integrated network analysis. PM 10 exposure was significantly associated with elevated fibrinogen levels, and five of the nine downregulated EV-miRNAs were mediators between PM 10 exposure and fibrinogen levels., Conclusions: Research on EVs opens a new path to the investigation of the adverse health effects of air pollution exposure. EVs have the potential to act both as markers of PM susceptibility and as potential molecular mechanism in the chain of events connecting PM exposure to increased coagulation, which is frequently linked to exposure and CVD development.

Human exposure to polycyclic aromatic hydrocarbons (PAHs) in indoor environments can be particularly relevant because people spend most of their time inside buildings, especially in homes. This study aimed to investigate the most important particle-bound PAH sources and exposure determinants in PM 2.5 samples collected in 19 homes located in northern Italy. Complementary information about ion content in PM 10 was also collected in 12 of these homes. Three methods were used for the identification of PAH sources and determinants: diagnostic ratios with principal component and hierarchical cluster analyses (PCA and HCA), chemical mass balance (CMB) and linear mixed models (LMMs). This combined and tiered approach allowed the infiltration of outdoor PAHs into indoor environments to be identified as the most important source in winter, with a relevant role played by biomass burning and traffic exhausts to be identified as a general source of PAHs in both seasons. Tobacco smoke exhibited an important impact on PAH levels in smokers' homes, whereas in the whole sample, cooking food and natural gas sources played a minor or negligible role. Nitrate, sulfate and ammonium were the main inorganic constituents of indoor PM 10 owing to the secondary formation of ammonium sulfates and nitrates., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The most advanced epidemiological studies on health effects of air pollution assign exposure to individuals based on residential outdoor concentrations of air pollutants measured or estimated at the front-door. In order to assess to what extent this approach could cause misclassification, indoor measurements were carried out in unoccupied rooms at the front and back of a building which fronted onto a major urban road. Simultaneous measurements were also carried out at adjacent outdoor locations to the front and rear of the building. Two 15-day monitoring campaigns were conducted in the period June-December 2013 in a building located in the urban area of Bologna, Italy. Particulate matter metrics including PM2.5 mass and chemical composition, particle number concentration and size distribution were measured. Both outdoor and indoor concentrations at the front of the building substantially exceeded those at the rear. The highest front/back ratio was found for ultrafine particles with outdoor concentration at the front door 3.4 times higher than at the rear. A weak influence on front/back ratios was found for wind direction. Particle size distribution showed a substantial loss of particles within the sub-50 nm size range between the front and rear of the building and a further loss of this size range in the indoor data. The chemical speciation data showed relevant reductions for most constituents between the front and the rear, especially for traffic related elements such as Elemental Carbon, Iron, Manganese and Tin. The main conclusion of the study is that gradients in concentrations between the front and rear, both outside and inside the building, are relevant and comparable to those measured between buildings located in high and low traffic areas. These findings show high potential for misclassification in the epidemiological studies that assign exposure based on particle concentrations estimated or measured at subjects' home addresses., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The European Regulation 1907/2006 (REACH--Registration, Evaluation, Authorization and Restriction of Chemicals) obliges manufacture companies and import chemicals to assess the risks arising from their use and to take the necessary measures to manage the risks identified. The Chemical Safety Report provides an accurate assessment of hazards to human health and the environment necessary to prepare an exposure scenario for the "identified uses" of the substance. An exposure scenario is the set of conditions that describe how the substance is manufactured or used during its life cycle and how the manufacturer or importer controls, or recommends downstream users to control the 'exposure to humans and the environment. Firms therefore need specific skills. The spectrum of toxicological risk is extremely large, the information required in some cases are very complex and undoubtedly require a thorough knowledge in toxicology and environmental industry. The expertise and experience in toxicology of the occupational physician in this case may become useful in the environmental field as well as another familiar figure of relevant importance is the occupational hygienist who develop exposure scenarios for workers and their uses experience for the exposure scenarios for the consumer. It provides an obvious involvement of medical toxicologists and occupational hygienists for public tasks of control and inspection of chemical safety reports and, locally, even the accuracy of risk that arise from this.