Fostering patient engagement through the co-design of seizure detection and monitoring technologies: A roadmap for collaboration between research and development.

The large number of technological developments suggests that patients with epilepsy can be better supported in the management of their seizures, especially when their condition is drug resistant. Patients and their caregivers, who are generally supportive of seizure detection and monitoring technologies, can provide relevant information to improve their effectiveness. We propose a comprehensive co-design approach to support more efficient development of seizure detection and monitoring technologies. Such an approach should follow the steps of the research and development process, take into account the temporal requirements characteristic of seizure management, focus on the themes of autonomy and self-management, and be guided by disease experts. If co-design practices are to continue to contribute to their development, they must also meet the scientific requirements of validity and reproducibility.

E-waste dismantling as a source of personal exposure and environmental release of fine and ultrafine particles.

Electronic waste (WEEE; from TV screens to electric toothbrushes) is one of the fastest growing waste streams in the world. Prior to recycling, e-waste components (metals, wood, glass, etc.) are processed by shredding, grinding and chainsaw cutting. These activities generate fine and ultrafine particle emissions, containing metals as well as organics (e.g., flame retardants), which have high potential for human health impacts as well as for environmental release. In this work, release of fine and ultrafine particles, and their exposure impacts, was assessed in an e-waste recycling facility under real-world operating conditions. Parameters monitored were black carbon, particle mass concentrations, ultrafine particles, and aerosol morphology and chemical composition. Potential health impacts were assessed in terms of cytotoxicity (cell viability) and oxidative stress (ROS) on <2 µm particles collected in liquid suspension. Environmental release of WEEE aerosols was evidenced by the higher particle concentrations monitored outside the facility when compared to the urban background (43 vs.11 µgPM2.5/m3, respectively, or 2.4 vs. 0.2 µgCa/m3). Inside the facility, concentrations were higher in the top than on the ground floor (PM2.5 = 147 vs. 78 µg/m3, N = 15.4 ∗ 104 vs. 8.7 ∗ 104/cm3, BC = 12.4 vs. 7.2 µg/m3). Ventilation was a key driver of human exposure, in combination with particle emissions. Key chemical tracers were Ca (from plastic fillers) and Fe (from wiring and other metal components). Y, Zr, Cd, Pb, P and Bi were markers of cathode TV recycling, and Li and Cr of grinding activities. While aerosols did not evidence cytotoxic effects, ROS generation was detected in 4 out of the 12 samples collected, associated to the ultrafine fraction. We conclude on the need for studies on aerosol emissions from WEEE facilities, especially in Europe, due to their demonstrable environmental and human health impacts and the rapidly growing generation of this type of waste.

Particle release from refit operations in shipyards: Exposure, toxicity and environmental implications.

European harbours are known to contribute to air quality degradation. While most of the literature focuses on emissions from stacks or logistics operations, ship refit and repair activities are also relevant aerosol sources in EU harbour areas. Main activities include abrasive removal of filler and spray painting with antifouling coatings/primers/topcoats. This work aimed to assess ultrafine particle (UFP) emissions from ship maintenance activities and their links with exposure, toxicity and health risks for humans and the aquatic environment. Aerosol emissions were monitored during mechanical abrasion of surface coatings under real-world operating conditions in two scenarios in the Mallorca harbour (Spain). Different types of UFPs were observed: (1) highly regular (triangular, hexagonal) engineered nanoparticles (Ti-, Zr-, Fe-based), embedded as nano-additives in the coatings, and (2) irregular, incidental particles emitted directly or formed during abrasion. Particle number concentrations monitored were in the range of industrial activities such as drilling or welding (up to 5 ∗ 105/cm3, mean diameters <30 nm). The chemical composition of PM4 aerosols was dominated by metallic tracers in the coatings (Ti, Al, Ba, Zn). In vitro toxicity of PM2 aerosols evidenced reduced cell viability and a moderate potential for cytotoxic effects. While best practices (exhaust ventilation, personal protective equipment, dust removal) were in place, it is unlikely that exposures and environmental release can be fully avoided at all times. Thus, it is advisable that health and safety protocols should be comprehensive to minimise exposures in all types of locations (near- and far-field) and periods (activity and non-activity). Potential release to coastal surface waters of metallic engineered and incidental nanomaterials, as well as fine and coarse particles (in the case of settled dust), should be assessed and avoided.

Characterizing the Chemical Profile of Incidental Ultrafine Particles for Toxicity Assessment Using an Aerosol Concentrator.

Incidental ultrafine particles (UFPs) constitute a key pollutant in industrial workplaces. However, characterizing their chemical properties for exposure and toxicity assessments still remains a challenge. In this work, the performance of an aerosol concentrator (Versatile Aerosol Concentration Enrichment System, VACES) was assessed to simultaneously sample UFPs on filter substrates (for chemical analysis) and as liquid suspensions (for toxicity assessment), in a high UFP concentration scenario. An industrial case study was selected where metal-containing UFPs were emitted during thermal spraying of ceramic coatings. Results evidenced the comparability of the VACES system with online monitors in terms of UFP particle mass (for concentrations up to 95 µg UFP/m3) and between filters and liquid suspensions, in terms of particle composition (for concentrations up to 1000 µg/m3). This supports the applicability of this tool for UFP collection in view of chemical and toxicological characterization for incidental UFPs. In the industrial setting evaluated, results showed that the spraying temperature was a driver of fractionation of metals between UF (<0.2 µm) and fine (0.2-2.5 µm) particles. Potentially health hazardous metals (Ni, Cr) were enriched in UFPs and depleted in the fine particle fraction. Metals vaporized at high temperatures and concentrated in the UF fraction through nucleation processes. Results evidenced the need to understand incidental particle formation mechanisms due to their direct implications on particle composition and, thus, exposure. It is advisable that personal exposure and subsequent risk assessments in occupational settings should include dedicated metrics to monitor UFPs (especially, incidental).

Effectiveness of nanoparticle exposure mitigation measures in industrial settings.

Inhalation of airborne nanoparticles is a well-known source of potentially health-hazardous occupational exposures. Effective mitigation measures are necessary to reduce exposure, but also challenging to implement due to the different characteristics of each individual emission source and industrial scenario. The present paper describes four different exposure case studies in the ceramic industry and quantifies the effectiveness of mitigation strategies implemented during: ceramic tile processing by thermal spraying, laser ablation, the use of diesel engines, and tile firing. The mitigation measures for exposure reduction were tailored to each industrial scenario. The NP removal efficiency of source enclosure (partial/full) combined with local exhaust ventilation (LEV) were quantified to range between 65 and 85% when the enclosure was partial. The efficiency reached 99% with full enclosure and vigorous ventilation (Air Change per Hour; ACH = 132 h-1). The elimination of the source was the optimal strategy to minimize exposure in the case of diesel forklifts use. The conventional ceramic kilns used intensively (>10 years) generated high NP exposure concentrations (>106/cm3). Appropriate maintenance and enhanced sealing enabled the reduction of exposure down to 52% of the initial value. It must be added that technologically advanced kilns, enabled even greater NP reductions (down to 84%), compared to the conventional ones. This proves technological improvements can lead to significant reduction of work exposures. This work evidences the need for tailored mitigation measures due to the broad variety of potential sources and activities in industrial scenarios. The quantitative efficiency rates reported here may be valuable for the adequate parametrization of exposure prediction and risk assessment models.

Health risk assessment from exposure to particles during packing in working environments.

Packing of raw materials in work environments is a known source of potential health impacts (respiratory, cardiovascular) due to exposure to airborne particles. This activity was selected to test different exposure and risk assessment tools, aiming to understand the effectiveness of source enclosure as a strategy to mitigate particle release. Worker exposure to particle mass and number concentrations was monitored during packing of 7 ceramic materials in 3 packing lines in different settings, with low (L), medium (M) and high (H) degrees of source enclosure. Results showed that packing lines L and M significantly increased exposure concentrations (119-609 µg m-3 respirable, 1150-4705 µg m-3 inhalable, 24,755-51,645 cm-3 particle number), while non-significant increases were detected in line H. These results evidence the effectiveness of source enclosure as a mitigation strategy, in the case of packing of ceramic materials. Total deposited particle surface area during packing ranged between 5.4 and 11.8 × 105 µm2 min-1, with particles depositing mainly in the alveoli (51-64%) followed by head airways (27-41%) and trachea bronchi (7-10%). The comparison between the results from different risk assessment tools (Stoffenmanager, ART, NanoSafer) and the actual measured exposure concentrations evidenced that all of the tools overestimated exposure concentrations, by factors of 1.5-8. Further research is necessary to bridge the current gap between measured and modelled health risk assessments.

Workplace exposure and release of ultrafine particles during atmospheric plasma spraying in the ceramic industry.

Atmospheric plasma spraying (APS) is a frequently used technique to produce enhanced-property coatings for different materials in the ceramic industry. This work aimed to characterise and quantify the impact of APS on workplace exposure to airborne particles, with a focus on ultrafine particles (UFPs, <100nm) and nanoparticles (<50nm). Particle number, mass concentrations, alveolar lung deposited surface area concentration, and size distributions, in the range 10nm-20µm were simultaneously monitored at the emission source, in the potential worker breathing zone, and in outdoor air. Different input materials (known as feedstock) were tested: (a) micron-sized powders, and (b) suspensions containing submicron- or nano-sized particles. Results evidenced significantly high UFP concentrations (up to 3.3×106/cm3) inside the spraying chamber, which impacted exposure concentrations in the worker area outside the spraying chamber (up to 8.3×105/cm3). Environmental release of UFPs was also detected (3.9×105/cm3, outside the exhaust tube). Engineered nanoparticle (ENP) release to workplace air was also evidenced by TEM microscopy. UFP emissions were detected during the application of both micron-sized powder and suspensions containing submicron- or nano-sized particles, thus suggesting that emissions were process- (and not material-) dependent. An effective risk prevention protocol was implemented, which resulted in a reduction of UFP exposure in the worker area. These findings demonstrate the potential risk of occupational exposure to UFPs during atmospheric plasma spraying, and raise the need for further research on UFP formation mechanisms in high-energy industrial processes.

Quartz dustiness: A key factor in controlling exposure to crystalline silica in the workplace.

The classification of Respirable Crystalline Silica (RCS) as carcinogenic for humans has drawn greater attention to crystalline silica exposure in the workplace in recent years, leading to recommendations by safety and health bodies in Europe and the U.S. for lower occupational exposure limits. In view of this new scenario, the present study examined quartz dustiness, as quartz handling is a major source of crystalline silica in the workplace. The study was conducted on test samples with different mean particle sizes, prepared from several commercial quartzes. The quartz particle samples were characterised and the influence of certain quartz particle parameters on quartz dustiness was determined. The results indicate that quartz dustiness may be significantly affected by mean particle size, specific surface area, the Hausner ratio, and fine particle content. The study shows that, in order to minimise the adverse health effects associated with the inhalation of crystalline silica, quartz dustiness may be deemed a key factor in controlling the generation of fugitive quartz emissions during quartz processing, both into the outside atmosphere (air pollution) and inside the facilities (occupational health).

Hipotermia inducida posparada cardiorrespiratoria / Induced hypothermia aftere cardiac arrest

Introducción. La muerte súbita cardiaca en el adulto es uno de los retos de la medicina cardiovascular. La parada cardiorrespiratoria (PCR) frecuentemente asocia daños neurológicos derivados de la hipoxia cerebral, y desencadena una serie de alteraciones celulo-tisulares que conducen a la lesión cerebral. La hipotermia terapéutica disminuye las demandas de oxígeno y actúa como protector. Objetivos. Describir la casuística de la hipotermia inducida (HI) pos PCR del Hospital Universitari de Bellvitge (HUB) desde 2009 hasta 2012. Elaborar una hoja de seguimiento del proceso de la hipotermia inducida. Reflejar la experiencia profesional de la HI pos PCR a través del seguimiento de un caso. Metodología. Estudio descriptivo retrospectivo de 54 casos, 45 hombres y 9 mujeres, con una edad media de 57 años (intervalo de 15 a 80) sometidos a HI pos PCR del HUB. Análisis de variables sociodemográficas, variables específicas y descripción de los criterios de inclusión de la HI. Diseño de registro de enfermería para plasmar los cuidados estandarizados que llevar a cabo durante el proceso de la HI y prueba piloto. Seguimiento de un paciente de 60 años que sufre PCR y a quien se somete a HI. Resultados. Principal causa de PCR: síndrome coronario agudo (SCA) (63 %). Ritmo inicial más representativo, taquicardia ventricular sin pulso/fibrilación ventricular (TVSP/FV) (68.5 %). Se objetiva mayor supervivencia en pacientes cuyas maniobras de RCP son inferiores a 30 minutos. La temperatura objetivo de los pacientes ha sido de 33 ºC durante 24 horas, a excepción de 5 casos, que se detuvieron por inestabilidad hemodinámica. Al alta hospitalaria 54 % son éxitus, 4 % presenta encefalopatía severa, 11 % encefalopatía leve y 31 % sin secuelas neurológicas. Se comprueba la aplicabilidad del registro de enfermería creado para el proceso de la HI, que permitió una visión global y rápida del procedimiento. Se describe la situación clínica del caso al ingreso, durante la HI, a las 48 horas, al alta de la Unidad Coronaria (UCC) y al alta hospitalaria. Discusión. Los datos recogidos en el centro de 2009 a 2012 de los pacientes con PCR candidatos a HI presentaron una favorable recuperación neurológica de los pacientes supervivientes. Asimismo, tienen mejor pronóstico los pacientes con PCR no prolongado, lo que coincide con estudios anteriores. Conclusiones. La HI es una terapia viable en el caso de pacientes que han sufrido PCR. Es importante realizar una valoración específica de cada uno de estos pacientes para posteriormente poder realizar la evaluación de los mismos (AU)

Introduction. Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. Objectives. To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. Methodology. Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of soiodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. Results. Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia / ventricular fibrillation (PVT / VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54 % were exitus, 4 % had severe encephalopathy, 11 % mild encephalopathy and 31 % without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. Discussion. The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. Conclusions. Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment (AU)

[INDUCED HYPOTHERMIA AFTER CARDIAC ARREST]. / Hipotermia inducida posparada cardiorrespiratoria.

INTRODUCTION: Sudden cardiac death in adults remains a challenge in cardiovascular medicine. Cardiac arrest often drives neurological damage resulting from cerebral hypoxia, causing a series of cellulose tissue alterations that lead to brain injury. Therapeutic hypothermia decreases oxygen demand acting as protection to the brain. OBJECTIVES: To describe the casuistry of hypothermia after retourn of spontaneous circulation (ROSC) at Bellvitge University Hospital (BUH) from 2009 to 2012. Develop a tracking sheet of the induced hypothermia process. Reflect professional experience of induced hypothermia after cardiac arrest through a case. METHODOLOGY: Retrospective descriptive study of the 54 cases, 45 men and 9 women, aged between ages 57 (15 to 80) years old treated with hypothermia after ROSC at BUH. Analysis of sociodemographic variables, specific variables and description of the inclusion criteria for hypothermia. Design of nursing record to express standardized care to undertake during the HI and its pilot trial. Monitoring a 60 years old patient who suffers cardiopulmonary arrest and is subjected to hypothermia. RESULTS: Leading cause of cardiopulmonary arrest is acute coronary syndrome (ACS) (63%). Most representative initial rhythm is pulseless ventricular tachycardia/ventricular fibrillation (PVT/VF) (68.5%). There is longer survival in patients whose CPR is less than 30 minutes. The.target temperature of the patients was 33 °C for 24 hours, except for 5 patients who were stopped because of hemodynamic instability. At discharge, 54% were exitus, 4% had severe encephalopathy, 11% mild encephalopathy and 31% without neurological sequel. The applicability of the nursing record that was created for the HI process was checked, which allowed a fast overview of the procedure. It describes the clinical status of the case on admission, during the HI, at 48 hours, at discharge from the coronary care unit (CCU) and at discharge. DISCUSSION: The data collected between 2009 and 2012 of patients with cardiopulmonary arrest candidates to hypothermia showed a favorable neurological recovery within the surviving patients. Additionally, patients with cardiopulmonary arrest not prolonged have a better prognosis agreeing with ROSC previous studies. CONCLUSIONS: Hypothermia is a viable therapy for patients who have undergone cardiopulmonary arrest. It is important to make a specific assessment of each case as well as agree the track record of care applied to these patients to subsequently allow their assessment.

Simple estimates of vehicle-induced resuspension rates.

Road dust emissions are considered to be a major source of airborne particulate matter (PM). This is particularly true for industrial environments, where there are high resuspension rates of deposited dust. The calculation of roads as PM emission sources has mostly focused on the consequences of this emission, viz. the increase in PM concentrations. That approach addresses the atmospheric transport of the emitted dust, and not its primary origin. In contrast, this paper examines the causes of the emission. The study is based on mass conservation of the dust deposited on the road surface. On the basis of this premise, estimates of emission rates were calculated from experimental data obtained in a road in a ceramic industrial area.

Impact of fugitive emissions in ambient PM levels and composition: a case study in Southeast Spain.

The results of this study show the high impact that anthropogenic fugitive emissions of mineral dust have on air quality (levels of PM(10), PM(2.5) and some metals) in a region in SE Spain named L'Alacantí. This could be extensive to other areas of Europe with similar characteristics. Fugitive emissions, such as those arising from large public construction works, cement and ceramic manufacturing, mining, heavy industries, handling and transport of powdered raw materials and road dust, are very often left out of emission monitoring and inspections in Europe. The comparative study of daily PM(10) series in the area shows how the increase of annual average PM(10) concentrations over 40 microg/m(3) is due to extreme episodes occurring in 2006 and 2007, at a regional scale, given the simultaneous recording of PM episodes at distant monitoring sites. The annual average values of the PM(10) concentrations were close to or slightly higher than 40 microg/m(3) (limit value of Directive 2008/50/CE) during 2006-2007 (Alicante-University 39-41, Agost 40-42, Sant Vicent 42-46, Alicante-El Plà 40-42 microg/m(3)). The main PM(10) sources in the zone were identified with the assistance of the PMF receptor model. Six common factors were determined, mineral as a main source (37% at Agost and 32% at Sant Vicent), road traffic, secondary sulfate, petroleum coke, sea spray and industry. Mineralogical studies, with XRD and SEM-EDX techniques, support the hypothesis that the highest PM episodes are associated to fugitive emissions of mineral matter. Despite the fact that L'Alacantí region is a heavily industrialized area with two cement plants and a significant number of ceramic manufacturing plants, the fugitive emissions may have accounted for the exceedances of the PM limit values during these two years, part of them caused by the construction of a highway. These results may contribute to the interpretation of prior studies on source apportionment carried out in Southern Europe, with very high loads of anthropogenic dust in PM(10) and PM(2.5).

PM10 speciation and determination of air quality target levels. A case study in a highly industrialized area of Spain.

The paper shows how PM speciation studies allow the evaluation of the strategies to be followed to diminish PM pollution in highly industrialized areas with a large number of potential pollution sources. Evolution of levels and speciation of PM10 in the ceramic producing area of Castelló (East Spain) was studied from April 2002 until December 2005. PM10 levels were measured at one rural (Borriana-rural), two suburban (Almassora and Onda) and three urban (Borriana-urban, L'Alcora and Vila-real) sites, all influenced by the ceramics industry. Average PM10 levels varied between 27 and 36 microg/m3 for the study period. Evaluation of 1996-2005 PM data from Onda shows a clear decrease of PM levels since the beginning of 2002. Summer peak levels and winter minima occurred at both rural and suburban sites, whereas urban sites had no clear seasonal trend, with high PM10 episodes being due variously to local, regional, and African dust intrusion events. PM10 chemical analysis at four of the sites showed the dominant constituent to be mineral matter, exceeding by 5-12 microg/m3 the usual ranges of annual mineral loadings in PM10 at comparable Spanish urban or regional background sites with no industrial influence. Given current PM10 loadings, we recommend a lowering target of 3-5 microg/m3 of the annual mean at the urban sites, which should be achievable given available emission abatement techniques.

Use of light and scanning electron microscopy to examine colonisation of barley rhizosphere by the nematophagous fungus Verticillium chlamydosporium.

Barley roots were readily colonised by the nematophagous fungus Verticillium chlamydosporium. Light microscopy (LM) but also low temperature scanning electron microscopy (LTSEM) revealed details of the colonisation process. Hyphae were found on the rhizoplane often with dictyochlamydospores. Hyphae of V. chlamydosporium penetrated epidermal cells, often by means of appressoria. A hyphal network was formed in epidermal and cortical cells. Likewise, hyphal coils were found within root cells next to transverse cell walls. Cortical cells were the limits of fungal colonisation, since no hyphae were seen in the vascular cylinder. Modifications of root cell contents (phenolic droplets and callose appositions) were common three weeks after inoculation with V. chlamydosporium. These features may indicate induction of plant defence reactions in late stages of root colonisation by the fungus. Both LTSEM and LM have proved extremely useful to describe root colonisation by the fungus. The results found may have implications in the mode action of nematophagous fungi against plant parasitic nematodes.