Coordination of chemical analyses under the European Human Biomonitoring Initiative (HBM4EU): Concepts, procedures and lessons learnt.

The European Human Biomonitoring Initiative (HBM4EU) ran from 2017 to 2022 with the aim of advancing and harmonizing human biomonitoring in Europe. More than 40,000 analyses were performed on human samples in different human biomonitoring studies in HBM4EU, addressing the chemical exposure of the general population, temporal developments, occupational exposure and a public health intervention on mercury in populations with high fish consumption. The analyses covered 15 priority groups of organic chemicals and metals and were carried out by a network of laboratories meeting the requirements of a comprehensive quality assurance and control system. The coordination of the chemical analyses included establishing contacts between sample owners and qualified laboratories and monitoring the progress of the chemical analyses during the analytical phase, also addressing status and consequences of Covid-19 measures. Other challenges were related to the novelty and complexity of HBM4EU, including administrative and financial matters and implementation of standardized procedures. Many individual contacts were necessary in the initial phase of HBM4EU. However, there is a potential to develop more streamlined and standardized communication and coordination in the analytical phase of a consolidated European HBM programme.

Air pollution in Sarajevo, Bosnia and Herzegovina, assessed by plant comet assay.

Bosnia and Herzegovina (B&H) is among the European countries with the highest rate of air pollution-related death cases and the poorest air quality. The main causes are solid fuel consumption, traffic, and the poorly developed or implemented air pollution reduction policies. In addition, the city of Sarajevo, the capital of B&H, suffers temperature inversion episodes in autumn/winter months, which sustain air pollution. Human biomonitoring studies may be confounded by the lifestyle of subjects or possible metabolic alterations. Therefore, this study aimed to evaluate Ligustrum vulgare L. as a model for air pollution monitoring by measuring DNA damage at one rural and two urban sites. DNA damage was measured as tail intensity (TI) in L. vulgare leaves, considering seasonal, sampling period, leaf position and staging, and spatial (urban versus rural) variation. Effects of COVID-19 lockdown on TI were assessed by periodical monitoring at one of the selected sites, while in-house grown L. vulgare plants were used to test differences between outdoor and indoor air pollution effects for the same sampling period. Significantly higher TI was generally observed in leaves collected in Campus in December 2020 and 2021 compared with March (P < 0.0001). Outer and adult leaves showed higher TI values, except for the rural site where no differences for these categories were found. Leaves collected in the proximity of the intensive traffic showed significantly higher TI values (P < 0.001), regardless of the sampling period and the stage of growth. In regards to the COVID-19 lockdown, higher TI (P < 0.001) was registered in December 2020, after the lockdown period, than in periods before COVID-19 outbreak or immediately after the lockdown in 2020. This also reflects mild air pollution conditions in summer. TI values for the in-house grown leaves were significantly lower compared to those in situ. Results showed that L. vulgare may present a consistent model for the air pollution biomonitoring but further studies are needed to establish the best association between L. vulgare physiology, air quality data, and air pollution effects.

UK DNA working group eDNA week, January 2022

Here, we report on eDNA week, an international conference held online as a five-day series of webinars from January 17, 2022, to January 21, 2022. The conference was organized by the UK DNA working group, which has witnessed considerable growth and application of eDNA research since its founding and first conference in 2014. The 2022 event, held online due to the COVID-19 pandemic, provided an opportunity to invite international researchers who are leading the field, without the usual constraints of conference location. Compared with the previous UK-based in-person conferences, there was greater international participation amongst the 514 people who registered to attend the event. To emphasize the importance of collaboration between sectors in driving forward DNA monitoring, a session was devoted to presentations by participants from governmental agencies, and another to those from commercial companies developing and utilizing DNA tools. The industry and stakeholder sessions were accompanied by state-of-the-art presentations delivered by a global group of DNA/eDNA researchers from 11 countries. These sessions were complemented by an open forum session for reflection and discussion. © 2022 The Authors. Environmental DNA published by John Wiley & Sons Ltd.

Wastewater-based epidemiology for the assessment of population exposure to chemicals: The need for integration with human biomonitoring for global One Health actions.

WBE has now become a complimentary tool in SARS-CoV-2 surveillance. This was preceded by the established application of WBE to assess the consumption of illicit drugs in communities. It is now timely to build on this and take the opportunity to expand WBE to enable comprehensive assessment of community exposure to chemical stressors and their mixtures. The goal of WBE is to quantify community exposure, discover exposure-outcome associations, and trigger policy, technological or societal intervention strategies with the overarching aim of exposure prevention and public health promotion. To achieve WBE's full potential, the following key aspects require further action: (1) Integration of WBE-HBM (human biomonitoring) initiatives that provide comprehensive community-individual multichemical exposure assessment. (2) Global WBE monitoring campaigns to provide much needed data on exposure in low- and middle-income countries (LMICs) and fill in the gaps in knowledge especially in the underrepresented highly urbanised as well as rural settings in LMICs. (3) Combining WBE with One Health actions to enable effective interventions. (4) Advancements in new analytical tools and methodologies for WBE progression to enable biomarker selection for exposure studies, and to provide sensitive and selective multiresidue analysis for trace multi-biomarker quantification in a complex wastewater matrix. Most of all, further developments of WBE needs to be undertaken by co-design with key stakeholder groups: government organisations, health authorities and private sector.

HBM4EU feasibility studies: Lessons learned in combining health and human biomonitoring studies.

BACKGROUND: The European Human Biomonitoring Initiative (HBM4EU) is a joint program evaluating humans' exposure to several environmental substances and their potential health effects. One of the main objectives of HBM4EU is to make use of human biomonitoring (HBM) to assess human exposure to chemicals in Europe to better understand the associated health impacts and to improve chemical risk assessment. In parallel to HBM studies, health examination surveys (HESs), nutrition/dietary surveys, and disease specific health surveys are conducted in many European countries. In HESs, information collected by questionnaire(s) is supplemented with physical examinations and analysis of clinical and biological biomarkers in biological samples. HBM and health examination survey (HES) use similar data collection methods and infrastructures hence the feasibility of combining these two is explored in this paper. METHODS: Within HBM4EU, three feasibility studies (in Finland, Germany, and UK/England) were conducted to evaluate opportunities and obstacles of combining HBM and health studies. In this paper we report lessons learned from these feasibility studies. RESULTS: The Finnish feasibility study called KouBio-KUOPIO study was a new initiative without links to existing studies. The German feasibility study added a HBM module to the first follow-up examination of the LIFE-Adult-Study, a population-based cohort study. The UK feasibility integrates a sustainable HBM module into the Health Survey for England (HSfE), an annual health examination survey. Benefits of combining HBM and HESs include the use of shared infrastructures. Furthermore, participants can receive additional health information from HES, and participation rates tend to be higher due to the potential to obtain personal health information. Preparatory phases including obtaining ethical approval can be time-consuming and complicated. Recruitment of participants and low participation rates are common concerns in survey research and therefore designing user-friendly questionnaires with low participant burden is important. Unexpected events such as the COVID-19 pandemic can cause substantial challenges and delays for such studies. Furthermore, experiences from several countries demonstrated that long-term funding for combined studies can be difficult to obtain. CONCLUSIONS: In the future, incorporating HBM modules into existing HESs can provide a feasible and cost-effective method to conduct HBM studies and obtain a wide range of relevant data to support public health policies and research.

Citizens' Perception and Concerns on Chemical Exposures and Human Biomonitoring-Results from a Harmonized Qualitative Study in Seven European Countries.

Exposure to different chemicals is an inevitable part of our everyday lives. Within HBM4EU, focus group discussions were conducted to gather data on citizens' perceptions of chemical exposure and human biomonitoring. These discussions were hosted in Cyprus, Denmark, Hungary, Israel, Latvia, the Netherlands, and North Macedonia following a protocol developed in the first round of discussions. Results indicate the very high concern of European citizens regarding food safety and the environment. Focus group participants were well aware of potential uptake of chemicals through food consumption (e.g., preservatives, flavor enhancers, coloring agents, pesticides, fertilizers, metals), drinking water, or from polluted air and water. One of the positive aspects identified here, is the high interest of citizens in awareness and education on personal measures to control exposure. The promotion of personal behavioral changes requires active involvement of society (e.g., commuting habits, energy choices, waste disposal, dietary habits). Activities should focus on raising awareness of the general public, implementation of policy measures, and mainstreaming of related topics into the education system. Raising awareness of the general public may promote engagement of citizens, which in turn may empower them to put pressure on politicians to take effective actions. There is also a need for further research which might focus on the impact of country-specific situations and of the COVID-19 pandemic on the exposure of citizens to chemicals.

Association between dietary exposure to bisphenols and body mass index in Spanish schoolchildren

The increase in children obesity worldwide has been of particular concern in recent decades. Environmental factors have been proposed as contributors to obesity, and there is a growing concern over obesogens, environmental chemicals with potential obesity‐related endocrine‐disrupting properties. In this regard, bisphenol A (BPA) and its analogues are suspected to have obesogenic properties. Current document report on the activities of the fellow, undertaken during the fourth, 2020–2021 cycle of the EU‐FORA programme at the University of Granada, Institute of Nutrition and Food Science, in Spain. The work programme offered by the hosting site was related to the extrapolation of bisphenols exposure following the determination of these compounds in food frequently consumed by children and in their biological samples. The fellow has participated in the recruitment of the study population in the health centres. In addition, she has participated in the collection of the children biological samples, anthropometric measurements and dietary surveys and in the optimisation of the laboratory methodology for the extraction of bisphenols in biological samples. All these activities also provided the fellow an opportunity to develop her data science related skills, which will benefit her professional development. In addition, the fellow gained an overview of various topics related to food safety risk assessment by attending the EU‐FORA dedicated training modules.

Structures, properties, and challenges of emerging 2D materials in bioelectronics and biosensors

Bioelectronics are powerful tools for monitoring and stimulating biological and biochemical processes, with applications ranging from neural interface simulation to biosensing. The increasing demand for bioelectronics has greatly promoted the development of new nanomaterials as detection platforms. Recently, owing to their ultrathin structures and excellent physicochemical properties, emerging two‐dimensional (2D) materials have become one of the most researched areas in the fields of bioelectronics and biosensors. In this timely review, the physicochemical structures of the most representative emerging 2D materials and the design of their nanostructures for engineering high‐performance bioelectronic and biosensing devices are presented. We focus on the structural optimization of emerging 2D material‐based composites to achieve better regulation for enhancing the performance of bioelectronics. Subsequently, the recent developments of emerging 2D materials in bioelectronics, such as neural interface simulation, biomolecular/biomarker detection, and skin sensors are discussed thoroughly. Finally, we provide conclusive views on the current challenges and future perspectives on utilizing emerging 2D materials and their composites for bioelectronics and biosensors. This review will offer important guidance in designing and applying emerging 2D materials in bioelectronics, thus further promoting their prospects in a wide biomedical field.

A framework for wastewater sample collection from a sewage cleanout to inform building-scale wastewater-based epidemiology studies.

Wastewater-based epidemiology (WBE) is a public health tool utilized for drug surveillance, and more recently, infectious disease monitoring of SARS-CoV-2. Sample collection is historically performed at a wastewater treatment plant, however, at this spatial resolution, much information related to actionable and contextually relevant community health data may be lost. Sampling from within the sewer collection system is now being employed more widely, bringing unique challenges, including health and safety concerns related to sample collection. As proof of concept, we tested the efficacy of sampling at the building-level from a sewer cleanout at an undisclosed location in Greater Phoenix, AZ, USA, to (i) test the feasibility of wastewater sample collection from this alternative access point, (ii) assess the advantages and limitations experienced for both maintenance-hole and cleanout-level sampling, (iii) screen for chemical analytes to evaluate detectability, and (iv) create a sampling framework for future near-source WBE investigations. Results indicate that use of a sewer cleanout compared to a maintenance hole is cost-effective, practical, and safe, while still preserving the anonymity and privacy for the contributing population. Additionally, of the 37 biomarkers screened over two sampling events, 20 were detected that cover a wide range of human behavior, exposure, and activity, indicating use of a sewer cleanout to be entirely feasible for downstream analysis. This reported success of sewer cleanout sampling for WBE and corresponding framework may allow practitioners to isolate specific complexes or buildings of interest, while avoiding challenges that can arise from maintenance hole sampling, thus allowing for widescale implementation of WBE for public health purposes.

The first detection of quaternary ammonium compounds in breast milk: Implications for early-life exposure.

BACKGROUND: Quaternary ammonium compounds (QACs), commonly used in cleaning, disinfecting, and personal care products, have recently gained worldwide attention due to the massive use of disinfectants during the COVID-19 pandemic. However, despite extensive use of these chemicals, no studies have focused on the analysis of QACs in human milk, a major route of exposure for infants. OBJECTIVE: Our objectives were to identify and measure QACs in breast milk and evaluate early-life exposure to this group of compounds for nursing infants. METHODS: Eighteen QACs, including 6 benzylalkyldimethyl ammonium compounds (BACs, with alkyl chain lengths of C8-C18), 6 dialkyldimethyl ammonium compounds (DDACs, C8-C18), and 6 alkyltrimethyl ammonium compounds (ATMACs, C8-C18), were measured in breast milk samples collected from U.S. mothers. Daily lactational intake was estimated based on the determined concentrations for 0-12 month old nursing infants. RESULTS: Thirteen of the 18 QACs were detected in breast milk and 7 of them were found in more than half of the samples. The total QAC concentrations (ΣQAC) ranged from 0.33 to 7.4 ng/mL (median 1.5 ng/mL). The most abundant QAC was C14-BAC with a median concentration of 0.45 ng/mL. The highest median ΣQAC estimated daily intake (EDI) was determined for <1-month old infants based on the average (using the median concentration) and high (using the 95th percentile concentration) exposure scenarios (230 and 750 ng/kg body weight/day, respectively). SIGNIFICANCE: Our findings provide the first evidence of the detection of several QACs in breast milk and identify breastfeeding as an exposure pathway to QACs for nursing infants. IMPACT STATEMENT: Our findings provide the first evidence of QAC occurrence in breast milk and identify breastfeeding as one of the exposure pathways to QACs for nursing infants.

Results of the national biomonitoring program show persistent iodine deficiency in Israel.

BACKGROUND: Adequate iodine intake is essential for human health, for normal thyroid function, and for attainment of full intellectual potential in children. In light of Israel's lack of a mandatory salt fortification policy, heavy reliance on desalination and low iodine intake from dairy products and seafood, there is concern in Israel that the population is iodine deficient. Indeed, the first Israeli National Iodine Survey in 2016 found a median urinary iodine concentration (UIC) of 83 µg/L among school age children, falling below the WHO's adequacy range of 100-299 µg/L for children. METHODS: In the framework of the National Human Biomonitoring Program in Israel, spot urine samples and questionnaire data were collected from 166 healthy children aged 4-12 years in 2020-2021. Urinary iodine concentrations were measured at the Ministry of Health National Biomonitoring Laboratory, using mass spectrometry. An international comparison of median urinary iodine concentrations (UIC) was performed taking into consideration the levels of desalinated water per capita, and fortification policies. RESULTS: The overall median (interquartile range [IQR]) UIC was 80.1 µg/L (44.7-130.8 µg/L) indicating that the population's iodine status has not improved in the five years that have passed since inadequacy was first identified. When comparing 13 countries with population size above 150,000, whose desalinated water per capita was at least 1 m3, Israel and Lebanon were the only countries with median UIC below the WHO adequacy range. CONCLUSIONS: There is an urgent need for mandatory salt fortification in Israel. Based on our international comparison, we conclude that the potential impact of desalination on iodine intake can be compensated for using the implementation of salt fortification policy. This study highlights the critical need for public health surveillance of nutritional and environmental exposures using human biomonitoring, with emphasis on vulnerable populations such as pregnant women and children.

Evaluating predictive relationships between wristbands and urine for assessment of personal PAH exposure.

During events like the COVID-19 pandemic or a disaster, researchers may need to switch from collecting biological samples to personal exposure samplers that are easy and safe to transport and wear, such as silicone wristbands. Previous studies have demonstrated significant correlations between urine biomarker concentrations and chemical levels in wristbands. We build upon those studies and use a novel combination of descriptive statistics and supervised statistical learning to evaluate the relationship between polycyclic aromatic hydrocarbon (PAH) concentrations in silicone wristbands and hydroxy-PAH (OH-PAH) concentrations in urine. In New York City, 109 participants in a longitudinal birth cohort wore one wristband for 48 h and provided a spot urine sample at the end of the 48-hour period during their third trimester of pregnancy. We compared four PAHs with the corresponding seven OH-PAHs using descriptive statistics, a linear regression model, and a linear discriminant analysis model. Five of the seven PAH and OH-PAH pairs had significant correlations (Pearson's r = 0.35-0.64, p ≤ 0.003) and significant chi-square tests of independence for exposure categories (p ≤ 0.009). For these five comparisons, the observed PAH or OH-PAH concentration could predict the other concentration within a factor of 1.47 for 50-80% of the measurements (depending on the pair). Prediction accuracies for high exposure categories were at least 1.5 times higher compared to accuracies based on random chance. These results demonstrate that wristbands and urine provide similar PAH exposure assessment information, which is critical for environmental health researchers looking for the flexibility to switch between biological sample and wristband collection.

Traffic restrictions during COVID-19 lockdown improve air quality and reduce metal biodeposition in tree leaves.

The coronavirus disease (COVID-19) has had a great global impact on human health, the life of people, and economies all over the world. However, in general, COVID-19´s effect on air quality has been positive due to the restrictions on social and economic activity. This study aimed to assess the impact on air quality and metal deposition of actions taken to reduce mobility in 2020 in two different urban locations. For this purpose, we analysed air pollution (NO2, NO, NOx, SO2, CO, PM10, O3) and metal accumulation in leaves of Tilia cordata collected from April to September 2020 in two cities in northern Spain (Pamplona-PA and San Sebastián-SS). We compared their values with data from the previous year (2019) (in which there were no mobility restrictions) obtained under an identical experimental design. We found that metal accumulation was mostly lower during 2020 (compared with 2019), and lockdown caused significant reductions in urban air pollution. Nitrogen oxides decreased by 33%-44%, CO by 24%-38%, and PM10 by 16%-24%. The contents of traffic-related metals were significantly reduced in both studied cities. More specifically, significant decreases in metals related to tyre and brake wear (Zn, Fe, and Cu) and road dust resuspension (Al, Ti, Fe, Mn, and Ca) were observed. With these results, we conclude that the main reason for the improvement in urban air pollutants and metals was the reduction in the use of cars due to COVID-19 lockdown. In addition, we offer some evidence indicating the suitability of T. cordata leaves as a tool for biomonitoring metal accumulation. This information is relevant for future use by the scientific community and policy makers to implement measures to reduce traffic air pollution in urban areas and to improve environmental and human health.

Moss Biomonitoring of Atmospheric Pollution with Trace Elements in the Moscow Region, Russia.

For the first time, moss biomonitoring covering the territory of the entire Moscow region, without including Moscow, was performed in 2020. Moss Pleurozium schreberi collected at 156 sampling sites were analyzed using neutron activation analysis and atomic absorption spectrometry. A total of 34 elements were determined in moss samples. Obtained data were compared with the results of the moss surveys performed in the Vladimir and Yaroslavl regions in 2018 and with the data of moss surveys conducted in the Moscow region on a limited number of sampling sites in 2004 and 2014. The Moscow region showed to be more polluted than the Vladimir and Yaroslavl regions. In the the Moscow region, the decrease of the content of the main part of the elements over time was noted. Trace elements emission sources were identified and characterized using factor analysis. Contamination Factor, Pollution Load Index, and Ecological Risk were calculated to assess the level of the region contamination and elements effect on human health. In general, the Moscow region can be characterized as unpolluted to moderately polluted with a low ecological risk of human exposure. The cities satellites around Moscow were determined to experience particular environmental stress, even in the period of the COVID-19 restrictions.

Health consequences of disinfection against SARS-CoV-2: Exploring oxidative stress damage using a biomonitoring approach.

Individuals who get involved in the disinfection of public settings using sodium hypochlorite might suffer adverse health effects. However, scarce information is available on the potential oxidative stress damage caused at low concentrations typically used for disinfection. We aimed to assess whether exposure to sodium hypochlorite during the COVID-19 pandemic causes oxidative stress damage in workers engaged in disinfection tasks. 75 operators engaged in the disinfection of public places were recruited as the case group, and 60 individuals who were not exposed to disinfectant were chosen as the control group. Spot urine samples were collected before (BE) and after exposure (AE) to disinfectants in the case group. Likewise, controls provided two spot urine samples in the same way as the case group. Urinary malondialdehyde (MDA) levels were quantified by forming thiobarbituric acid reactive substances in the urine. In addition, the concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the urine was determined using an ELISA kit. Results showed significant differences in the urinary levels of oxidative stress markers, where median 8-OHdG (AE case: 3.84 ± 2.89 µg/g creatinine vs AE control 2.54 ± 1.21 µg/g creatinine) and MDA (AE case: 169 ± 89 µg/g creatinine vs AE control 121 ± 47 µg/g creatinine) levels in case group AE samples were 1.55 and 1.35-times higher than the control group AE samples (P < 0.05), respectively. Besides, urinary levels of oxidative stress markers in AE samples of the case group were significantly higher than in BE samples (8-OHdG BE 3.40 ± 1.95 µg/g creatinine, MDA BE 136 ± 51.3 µg/g creatinine, P < 0.05). Our results indicated that exposure to even low levels of sodium hypochlorite used in disinfection practices might cause oxidative stress related damage. With this in mind, implementing robust protective measures, such as specific respirators, is crucial to reduce the health burdens of exposure to disinfectants.

Effect of the coronavirus pandemic lockdown to elemental composition of peat mosses.

Sphagnum mosses are used for biomonitoring air pollution. In 2019, samples were taken from two peat bogs areas in Germany and two in Slovenia to determine differences in their levels of potentially toxic elements (PTE). The Coronavirus Disease (COVID-19) lockdown caused a global decrease in air pollution. Therefore, we repeated the monitoring in 2020 to see if this was also reflected in moss composition. Despite the variability within bogs and the areas, it is possible to distinguish the degree of air pollution between the two countries. In comparison to 2019, the German mosses have higher contents of almost all elements and the Slovenian are enriched in Cr and Hg in 2020. Comparison of the PTE contents, their ratios to Sc, and the enrichment factors show that the COVID-19 lockdown led to a decrease in long-range pollutants bound to finest particles and increased the influence of local soil dusting. The effect prevailed over lower precipitation in 2020 compared to 2019. Transport and industry continued to contribute significantly to contamination. Sphagnum mosses proved to be good indicators of the spatial and temporal extent of pollution. Even relatively short periods of lower air pollution are reflected in moss PTE contents.

Quaternary Ammonium Compounds: Bioaccumulation Potentials in Humans and Levels in Blood before and during the Covid-19 Pandemic.

Quaternary ammonium compounds (QACs) are commonly used in a variety of consumer, pharmaceutical, and medical products. In this study, bioaccumulation potentials of 18 QACs with alkyl chain lengths of C8-C18 were determined in the in vitro-in vivo extrapolation (IVIVE) model using the results of human hepatic metabolism and serum protein binding experiments. The slowest in vivo clearance rates were estimated for C12-QACs, suggesting that these compounds may preferentially build up in blood. The bioaccumulation of QACs was further confirmed by the analysis of human blood (sera) samples (n = 222). Fifteen out of the 18 targeted QACs were detected in blood with the ΣQAC concentrations reaching up to 68.6 ng/mL. The blood samples were collected during two distinct time periods: before the outbreak of the COVID-19 pandemic (2019; n = 111) and during the pandemic (2020, n = 111). The ΣQAC concentrations were significantly higher in samples collected during the pandemic (median 6.04 ng/mL) than in those collected before (median 3.41 ng/mL). This is the first comprehensive study on the bioaccumulation and biomonitoring of the three major QAC groups and our results provide valuable information for future epidemiological, toxicological, and risk assessment studies targeting these chemicals.

Phthalate esters in face masks and associated inhalation exposure risk.

This study assessed the composition of single-use face mask materials, quantified the concentration of phthalate esters in masks and evaluated associated inhalation exposure risk. All the mask samples, including 12 surgical and four N95/P1/P2 masks, were identified to be made of polypropylene, with polyethylene terephthalate present in the N95/P1/P2 masks. Di-methyl phthalate, di-n-butyl phthalate, di-ethyl phthalate, di-isobutyl phthalate and di(2-ethylhexyl) phthalate were frequently detected and their concentration summed up 55 ± 35 ~ 1700 ± 140 ng per surgical mask and 2300 ± 150 ~ 5200 ± 800 ng per N95/P1/P2 mask. Our simulation experiment suggested a mean loss of 13 - 71% of phthalate mass depending on compounds, during 5-hour wearing of these masks. This resulted in an estimated daily intake of individual compounds no higher than 20 ng/kg/day for adults and 120 ng/kg/day for toddlers, which were at least 80 times lower compared to relevant tolerable daily intake values. Two interventional trials were conducted where a volunteer wore a mask for four hours and urine samples were collected before and after the mask wearing. No obvious increase was observed for the urinary concentration of any phthalate metabolite, indicating minimal contribution to overall exposure to phthalate esters.

Remote Monitoring of Critically-Ill Post-Surgical Patients: Lessons from a Biosensor Implementation Trial.

Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in healthcare with significant acceleration due to the COVID-19 pandemic. However, few studies have attempted to narrate, or systematically analyze, the process of their implementation. We performed an observational study of biosensor implementation. The data accuracy provided by the commercially available biosensors was compared to those offered by standard clinical monitoring on patients admitted to the intensive care unit/perioperative unit. Surveys were also conducted to examine the acceptance of technology by patients and medical staff. We demonstrated a significant difference in vital signs between sensors and standard monitoring which was very dependent on the measured variables. Sensors seemed to integrate into the workflow relatively quickly, with almost no reported problems. The acceptance of the biosensors was high by patients and slightly less by nurses directly involved in the patients' care. The staff forecast a broad implementation of biosensors in approximately three to five years, yet are eager to learn more about them. Reliability considerations proved particularly troublesome in our implementation trial. Careful evaluation of sensor readiness is most likely necessary prior to system-wide implementation by each hospital to assess for data accuracy and acceptance by the staff.

Domiciliary Hospitalization through Wearable Biomonitoring Patches: Recent Advances, Technical Challenges, and the Relation to Covid-19.

This article reviews recent advances and existing challenges for the application of wearable bioelectronics for patient monitoring and domiciliary hospitalization. More specifically, we focus on technical challenges and solutions for the implementation of wearable and conformal bioelectronics for long-term patient biomonitoring and discuss their application on the Internet of medical things (IoMT). We first discuss the general architecture of IoMT systems for domiciliary hospitalization and the three layers of the system, including the sensing, communication, and application layers. In regard to the sensing layer, we focus on current trends, recent advances, and challenges in the implementation of stretchable patches. This includes fabrication strategies and solutions for energy storage and energy harvesting, such as printed batteries and supercapacitors. As a case study, we discuss the application of IoMT for domiciliary hospitalization of COVID 19 patients. This can be used as a strategy to reduce the pressure on the healthcare system, as it allows continuous patient monitoring and reduced physical presence in the hospital, and at the same time enables the collection of large data for posterior analysis. Finally, based on the previous works in the field, we recommend a conceptual IoMT design for wearable monitoring of COVID 19 patients.