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Introduction: Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.Methods: This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic.Results: We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001).Conclusion: Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.

Objectives: In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose–response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks. Methods: Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause‐specific (CS) Cox‐regression models were used to evaluate the dose‐exposure relationship between asbestosis mortality and the time‐dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death. Results: The cohort included 12,963 asbestos cement workers. During the follow‐up period (1960−2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose–response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL‐years. Lung cancer and circulatory diseases were the main competing causes of death. Conclusions: Asbestos exposure among Italian asbestos‐cement workers has led to a very high number of deaths from asbestosis and asbestos‐related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis. [ABSTRACT FROM AUTHOR]

Background: Recent studies supported the association between occupational exposure to asbestos and risk of cholangiocarcinoma (CC). Aim of the present study is to investigate this association using an update of mortality data from the Italian pooled asbestos cohort study and to test record linkage to Cancer Registries to distinguish between hepatocellular carcinoma (HCC) and intrahepatic/extrahepatic forms of CC. Methods: The update of a large cohort study pooling 52 Italian industrial cohorts of workers formerly exposed to asbestos was carried out. Causes of death were coded according to ICD. Linkage was carried out for those subjects who died for liver or bile duct cancer with data on histological subtype provided by Cancer Registries. Results: 47 cohorts took part in the study (57,227 subjects). We identified 639 causes of death for liver and bile duct cancer in the 44 cohorts covered by Cancer Registry. Of these 639, 240 cases were linked to Cancer Registry, namely 14 CC, 83 HCC, 117 cases with unspecified histology, 25 other carcinomas, and one case of cirrhosis (likely precancerous condition). Of the 14 CC, 12 occurred in 2010-2019, two in 2000-2009, and none before 2000. Conclusion: Further studies are needed to explore the association between occupational exposure to asbestos and CC. Record linkage was hampered due to incomplete coverage of the study areas and periods by Cancer Registries. The identification of CC among unspecific histology cases is fundamental to establish more effective and targeted liver cancer screening strategies. [ABSTRACT FROM AUTHOR]

Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM), often referred to as 3D printing, is an emerging technology with a wide range of industrial applications and process typologies. Although the release of metal nanoparticles as by-products could occur, occupational exposure limits and cogent safety standards are not currently available due to the novelty of the technology. To support the definition of benchmarks, this study aims to provide a preliminary comparison between the nanoparticle release patterns of laser metal deposition, adopting different feedstocks, namely, metal wire and metal powder. The monitored device is a university research setup, and the work presents the results of two different processes with AISI 316 L as a feedstock in powder and wired form, respectively. The monitoring confirmed the outcomes of previous studies, with a high release of nanoparticles from the powder head on the device (average 138,713 n/cm3 during printing, with maximum values exceeding 106 n/cm3). Moreover, the results show a significant concentration of nanoparticles with a wire head during the printing phase (average release of 628,156 n/cm3 with a maximum of 1,114,987 n/cm3) and pauses (average of 32,633 n/cm3 and a maximum of 733,779 n/cm3). The monitored values during pauses are particularly relevant since no personal protection equipment was used in the wire processes and the operators could access the printing room during pauses for device interventions, thus being exposed to significant nanoparticle concentrations. This study presents a preliminary evaluation of the potential exposure during laser metal deposition while implementing different technologies and provides evidence for defining effective operational safety procedures for the operators. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy.Method: The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE).Result: Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE.Conclusion: The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality. [ABSTRACT FROM AUTHOR]

Laser Powder Bed Fusion (L-PBF) is a well-known Additive Manufacturing (AM) technology with a wide range of industrial applications. Potential occupational exposures to metal nanoparticles (NP) as by-products could occur in these processes, and no cogent occupational exposure limits are available. To contribute to this assessment, a monitoring campaign to measure the NP release pattern in two metal L-PBF facilities was carried out in two academic laboratories adopting L-PBF technology for research purposes. The monitored processes deal with two devices and three feedstock types, namely stainless steel (AISI 316L), aluminium-silicon alloy (A357) and pure copper, which are associated with different levels of industrial maturity. Prolonged environmental and personal real-time monitoring of NP concentration and size were performed, temperature and relative humidity were also measured during environmental monitoring. The measurements reveal a controlled NP release of the monitored processes, resulting in an average reduced exposure of the operators during the whole working shift, in compliance with proposed limit values (20 000 n cm−3 for density >6000 kg m−3 or 40 000 n cm−3 for density <6000 kg m−3). Nonetheless, the monitoring results show release events with an increase in NP concentration and a decrease in NP size corresponding with several actions usually performed during warm-up and cleaning, leading to exposures over 40–50 000 n cm−3 during a considerable time interval, especially during the manufacturing of pure copper powder. The results show that the actions of the operators, boundary conditions (relative humidity) and set-up of the L-PBF device have an impact on the amount of NP released and their size. Several release events (significant increase in NP concentration and decrease in NP size) are identified and associated with specific job tasks of the workers as well as building conditions. These results contribute to the definition of NP release benchmarks in AM processes and provide information to improve the operational conditions of L-PBF processes as well as safety guidelines for operators. [ABSTRACT FROM AUTHOR]

Background: Cooking and fuel combustion in the indoor environment are major sources of respirable suspended particulate matter (RSPM), which is an excellent carrier of potentially harmful absorbed inorganic and organic compounds. Chronic exposure to RSPM can lead to acute pulmonary illness, asthma, cardiovascular disease, and lung cancer in people involved in cooking. Despite this, questions remain about the harmfulness of different particulate matter (PM) sources generated during cooking, and the factors influencing PM physico-chemical properties. The most reliable methods for sampling and analyzing cooking emissions remain only partially understood. Objectives: This review aims to comprehensively assess the risks of PM generated during cooking, considering the main sources of PM, PM chemical composition, and strategies for PM physico-chemical analysis. We present the first systematic analysis of PM sources and chemical composition related to cooking. We highlight significant differences between studies using different experimental conditions, with a lack of a standard methodology. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement rules and the Patient, Intervention, Comparison, and Outcome (PICO) strategy for scientific research, three different scientific databases (PubMed, Scopus, and Web of Science) were screened to find scientific articles that measure, collect, and analyze the chemical composition of nanometer- and micrometer-sized PM generated during cooking activities under different conditions. Data are summarized to assess risk, evaluating the main sources and factors influencing PM generation, their chemical composition, and how they have been collected and analyzed in changing experimental conditions. Results: From 2474 search results, there were 55 studies that met our criteria. Overall, the main variable sources of PM in cooking activities relate to the stove and fuel type. The concentration and chemical–physical properties of PM are also strongly influenced by the food and food additive type, food processing type, cooking duration, temperature, and utensils. The most important factor influencing indoor PM concentration is ventilation. The PM generated during cooking activities is composed mainly of elemental carbon (EC) and its derivatives, and the porous structure of PM with high surface-to-volume ratio is a perfect carrier of inorganic and organic matter. Conclusions: This review reveals a growing interest in PM exposure during cooking activities and highlights significant variability in the chemical–physical properties of particles, and thus variable exposure risks. Precise risk characterization improves possible preventive strategies to reduce the risk of indoor pollutant exposure. However, comprehensive PM analysis needs proper sampling and analysis methods which consider all factors influencing the physico-chemical properties of PM in an additive and synergistic way. Our analysis highlights the need for method standardization in PM environmental analyses, to ensure accuracy and allow deeper comparisons between future studies. [ABSTRACT FROM AUTHOR]

This paper presents the results of a measurement campaign for assessing the release of particles and the potential exposure of workers in metal additive manufacturing. The monitoring deals with three environments, i.e., two academic laboratories and one production site, while printing different metallic alloys for chemical composition and size. The monitored devices implement different metal 3D printing processes, named Selective Laser Melting, Laser Metal Deposition and Hybrid Laser Metal Deposition, providing a wide overview of the current laserbased Additive Manufacturing technologies. Despite showing the generation of metal powders during the printing processes, the usual measurements based on gravimetric analysis did not highlight concentrations higher than the international exposure limits for the selected metals (i.e., chromium, cobalt, iron, nickel, and copper). Additional data, collected through a cascade impactor and particle counter coupled with the achievements from previous measurements reported in literature, indicate that during the printing operations, fine and ultrafine metal particles might be generated. Finally, the authors introduced a preliminary characterisation of the particles released during the different phases of the investigated AM processes (powder charging, printing, part cleaning and support removal), highlighting how the different operations may affect the particle size and concentration. [ABSTRACT FROM AUTHOR]

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