Automatic detection of oesophageal intubation based on ventilation pressure waveforms shows high sensitivity and specificity in patients with pulmonary disease

Background: Unrecognised endotracheal tube misplacement in emergency intubations has a reported incidence of up to 17%. Current detection methods have many limitations restricting their reliability and availability in these circumstances. There is therefore a clinical need for a device that is small enough to be practical in emergency situations and that can detect oesophageal intubation within seconds. In a first reported evaluation, we demonstrated an algorithm based on pressure waveform analysis, able to determine tube location with high reliability in healthy patients. The aim of this study was to validate the specificity of the algorithm in patients with abnormal pulmonary compliance, and to demonstrate the reliability of a newly developed small device that incorporates the technology. Materials and methods: Intubated patients with mild to moderate lung injury, admitted to intensive care were included in the study. The device was connected to the endotracheal tube, and three test ventilations were performed in each patient. All diagnostic data were recorded on PC for subsequent specificity/sensitivity analysis. Results and discussion: A total of 105 ventilations in 35 patients with lung injury were analysed. With the threshold D-value of 0.1, the system showed a 100% sensitivity and specificity to diagnose tube location. Conclusion: The algorithm retained its specificity in patients with decreased pulmonary compliance. We also demonstrated the feasibility to integrate sensors and diagnostic hardware in a small, portable hand-held device for convenient use in emergency situations

Effectiveness of rotavirus vaccination in prevention of hospital admissions for rotavirus gastroenteritis among young children in Belgium : case-control study

Objective : To evaluate the effectiveness of rotavirus vaccination among young children in Belgium. Design : Prospective case-control study. Setting : Random sample of 39 Belgian hospitals, February 2008 to June 2010. Participants : 215 children admitted to hospital with rotavirus gastroenteritis confirmed by polymerase chain reaction and 276 age and hospital matched controls. All children were of an eligible age to have received rotavirus vaccination (that is, born after 1 October 2006 and aged >= 14 weeks). Main outcome measure : Vaccination status of children admitted to hospital with rotavirus gastroenteritis and matched controls. Results : 99 children (48%) admitted with rotavirus gastroenteritis and 244 (91%) controls had received at least one dose of any rotavirus vaccine (P= 12 months. The G2P[4] genotype accounted for 52% of cases confirmed by polymerase chain reaction with eligible matched controls. Vaccine effectiveness was 85% (64% to 94%) against G2P[4] and 95% (78% to 99%) against G1P[8]. In 25% of cases confirmed by polymerase chain reaction with eligible matched controls, there was reported co-infection with adenovirus, astrovirus and/or norovirus. Vaccine effectiveness against co-infected cases was 86% (52% to 96%). Effectiveness of at least one dose of any rotavirus vaccine (intention to vaccinate analysis) was 91% (82% to 95%). Conclusions : Rotavirus vaccination is effective for the prevention of admission to hospital for rotavirus gastroenteritis among young children in Belgium, despite the high prevalence of G2P[4] and viral co-infection

urinary metabolomics study of workers exposed to hexavalent chromium

Exposure to hexavalent chromium Cr(VI) may occur in several occupational activities, placing workers in many industries at risk for potential related health outcomes. Untargeted metabolomics was applied to investigate changes in metabolic pathways in response to Cr(VI) exposure. We obtained our data from a study population of 220 male workers with exposure to Cr(VI) and 102 male controls from Belgium, Finland, Poland, Portugal and the Netherlands within the HBM4EU Chromates Study. Urinary metabolite profiles were determined using liquid chromatography mass spectrometry, and differences between post-shift exposed workers and controls were analyzed using principal component analysis. Based on the first two principal components, we observed clustering by industrial chromate application, such as welding, chrome plating, and surface treatment, distinct from controls and not explained by smoking status or alcohol use. The changes in the abundancy of excreted metabolites observed in workers reflect fatty acid and monoamine neurotransmitter metabolism, oxidative modifications of amino acid residues, the excessive formation of abnormal amino acid metabolites and changes in steroid and thyrotropin-releasing hormones. The observed responses could also have resulted from work-related factors other than Cr(VI). Further targeted metabolomics studies are needed to better understand the observed modifications and further explore the suitability of urinary metabolites as early indicators of adverse effects associated with exposure to Cr(VI).publishersversionpublishe

usefulness of measurement of blood chromium levels in the assessment of occupational Cr(VI) exposure

Funding Information: This work has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. Luxembourg entered the study at a later stage and thus financed the study at its own means. Publisher Copyright: © 2022 The AuthorsOccupational exposures to hexavalent Chromium (Cr(VI)) can occur in welding, hot working stainless steel processing, chrome plating, spray painting and coating activities. Recently, within the human biomonitoring for Europe initiative (HBM4EU), a study was performed to assess the suitability of different biomarkers to assess the exposure to Cr(VI) in various job tasks. Blood-based biomarkers may prove useful when more specific information on systemic and intracellular bioavailability is necessary. To this aim, concentrations of Cr in red blood cells (RBC-Cr) and in plasma (P–Cr) were analyzed in 345 Cr(VI) exposed workers and 175 controls to understand how these biomarkers may be affected by variable levels of exposure and job procedures. Compared to controls, significantly higher RBC-Cr levels were observed in bath plating and paint application workers, but not in welders, while all the 3 groups had significantly greater P–Cr concentrations. RBC-Cr and P–Cr in chrome platers showed a high correlation with Cr(VI) in inhalable dust, outside respiratory protective equipment (RPE), while such correlation could not be determined in welders. In platers, the use of RPE had a significant impact on the relationship between blood biomarkers and Cr(VI) in inhalable and respirable dust. Low correlations between P–Cr and RBC-Cr may reflect a difference in kinetics. This study showed that Cr-blood-based biomarkers can provide information on how workplace exposure translates into systemic availability of Cr(III) (extracellular, P–Cr) and Cr(VI) (intracellular, RBC-Cr). Further studies are needed to fully appreciate their use in an occupational health and safety context.publishersversionpublishe

HBM4EU Occupational Biomonitoring Study on e-Waste—Study Protocol

Funding Information: This work has received external funding from the European Union?s Horizon 2020 research and innovation program under grant agreement No. 733032 and received co-funding from the author?s organizations and/or Ministries. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Workers involved in the processing of electronic waste (e-waste) are potentially exposed to toxic chemicals. If exposure occurs, this may result in uptake and potential adverse health effects. Thus, exposure surveillance is an important requirement for health risk management and prevention of occupational disease. Human biomonitoring by measurement of specific biomarkers in body fluids is considered as an effective method of exposure surveillance. The aim of this study is to investigate the internal exposure of workers processing e-waste using a human biomonitoring approach, which will stimulate improved work practices and contribute to raising awareness of potential hazards. This exploratory study in occupational exposures in e-waste processing is part of the European Human Biomonitoring Initiative (HBM4EU). Here we present a study protocol using a cross sectional survey design to study worker’s exposures and compare these to the exposure of subjects preferably employed in the same company but with no known exposure to industrial recycling of e-waste. The present study protocol will be applied in six to eight European countries to ensure standardised data collection. The target population size is 300 exposed and 150 controls. Biomarkers of exposure for the following chemicals will be used: chromium, cadmium and lead in blood and urine; brominated flame retardants and polychlorobiphenyls in blood; mercury, organophosphate flame retardants and phthalates in urine, and chromium, cadmium, lead and mercury in hair. In addition, the following effect biomarkers will be studied: micronuclei, epigenetic, oxidative stress, inflammatory markers and telomere length in blood and metabolomics in urine. Occupational hygiene sampling methods (airborne and settled dust, silicon wristbands and handwipes) and contextual information will be collected to facilitate the interpretation of the biomarker results and discuss exposure mitigating interventions to further reduce exposures if needed. This study protocol can be adapted to future European-wide occupational studiespublishersversionPeer reviewe

HBM4EU chromates study: determinants of exposure to hexavalent chromium in plating, welding and other occupational settings

Work-related exposures in industrial processing of chromate (chrome plating, surface treatment, and welding) raise concerns regarding the health risk of hexavalent chromium (Cr(VI)). In this study, performed under the HBM4EU project, we focused on better understanding the determinants of exposure and recognising how risk management measures (RMMs) contribute to a reduction in exposure. HBM and occupational hygiene data were collected from 399 workers and 203 controls recruited in nine European countries. Urinary total chromium (U-Cr), personal inhalable and respirable dust of Cr and Cr(VI), and Cr from hand wipes were collected. Data on the RMMs were collected by questionnaires. We studied the association between different exposure parameters and the use of RMMs. The relationship between exposure by inhalation and U-Cr in different worker groups was analysed using regression analysis and found a strong association. Automatisation of Cr electroplating dipping explained lower exposure levels in platers. The use of personal protective equipment resulted in lower U-Cr levels in welding, bath plating, and painting. An effect of wearing gloves was observed in machining. An effect of local exhaust ventilation and training was observed in welding. Regression analyses showed that in platers, exposure to an air level of 5 µg/m3 corresponds to a U-Cr level of 7 µg/g of creatinine. In welders, the same inhalation exposure resulted in lower U-Cr levels reflecting toxicokinetic differences of different chromium species.info:eu-repo/semantics/publishedVersio

HBM4EU chromates study - Usefulness of measurement of blood chromium levels in the assessment of occupational Cr(VI) exposure

Occupational exposures to hexavalent Chromium (Cr(VI)) can occur in welding, hot working stainless steel processing, chrome plating, spray painting and coating activities. Recently, within the human biomonitoring for Europe initiative (HBM4EU), a study was performed to assess the suitability of different biomarkers to assess the exposure to Cr(VI) in various job tasks. Blood-based biomarkers may prove useful when more specific information on systemic and intracellular bioavailability is necessary. To this aim, concentrations of Cr in red blood cells (RBC-Cr) and in plasma (P-Cr) were analyzed in 345 Cr(VI) exposed workers and 175 controls to understand how these biomarkers may be affected by variable levels of exposure and job procedures. Compared to controls, significantly higher RBC-Cr levels were observed in bath plating and paint application workers, but not in welders, while all the 3 groups had significantly greater P-Cr concentrations. RBC-Cr and P-Cr in chrome platers showed a high correlation with Cr(VI) in inhalable dust, outside respiratory protective equipment (RPE), while such correlation could not be determined in welders. In platers, the use of RPE had a significant impact on the relationship between blood biomarkers and Cr(VI) in inhalable and respirable dust. Low correlations between P-Cr and RBC-Cr may reflect a difference in kinetics. This study showed that Cr-blood-based biomarkers can provide information on how workplace exposure translates into systemic availability of Cr(III) (extracellular, P-Cr) and Cr(VI) (intracellular, RBC-Cr). Further studies are needed to fully appreciate their use in an occupational health and safety context.Highlights: - Suitability of blood biomarkers was evaluated to assess occupational Cr(VI)exposure; - Bath platers and painters had higher Red Blood Cells-Cr levels compared to controls; - Bath platers, painters and welders had higher plasma-Cr levels compared to controls; Red Blood Cells- and Plasma-Cr were highly correlated with inhalable Cr(VI) in platers; Blood-Cr biomarkers can provide information on systemic and intracellular availability.This work has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author’s organizations and/or Ministries. Luxembourg entered the study at a later stage and thus financed the study at its own means.info:eu-repo/semantics/publishedVersio

HBM4EU Occupational Biomonitoring Study on e-Waste—Study Protocol

Funding Information: This work has received external funding from the European Union?s Horizon 2020 research and innovation program under grant agreement No. 733032 and received co-funding from the author?s organizations and/or Ministries. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Workers involved in the processing of electronic waste (e-waste) are potentially exposed to toxic chemicals. If exposure occurs, this may result in uptake and potential adverse health effects. Thus, exposure surveillance is an important requirement for health risk management and prevention of occupational disease. Human biomonitoring by measurement of specific biomarkers in body fluids is considered as an effective method of exposure surveillance. The aim of this study is to investigate the internal exposure of workers processing e-waste using a human biomonitoring approach, which will stimulate improved work practices and contribute to raising awareness of potential hazards. This exploratory study in occupational exposures in e-waste processing is part of the European Human Biomonitoring Initiative (HBM4EU). Here we present a study protocol using a cross sectional survey design to study worker’s exposures and compare these to the exposure of subjects preferably employed in the same company but with no known exposure to industrial recycling of e-waste. The present study protocol will be applied in six to eight European countries to ensure standardised data collection. The target population size is 300 exposed and 150 controls. Biomarkers of exposure for the following chemicals will be used: chromium, cadmium and lead in blood and urine; brominated flame retardants and polychlorobiphenyls in blood; mercury, organophosphate flame retardants and phthalates in urine, and chromium, cadmium, lead and mercury in hair. In addition, the following effect biomarkers will be studied: micronuclei, epigenetic, oxidative stress, inflammatory markers and telomere length in blood and metabolomics in urine. Occupational hygiene sampling methods (airborne and settled dust, silicon wristbands and handwipes) and contextual information will be collected to facilitate the interpretation of the biomarker results and discuss exposure mitigating interventions to further reduce exposures if needed. This study protocol can be adapted to future European-wide occupational studiespublishersversionPeer reviewe

The HBM4EU chromates study – Outcomes and impacts on EU policies and occupational health practices

Within the EU human biomonitoring initiative (HBM4EU), a targeted, multi-national study on occupational exposure to hexavalent chromium (Cr(VI)) was performed. Cr(VI) is currently regulated in EU under REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) and under occupational safety and health (OSH) legislation. It has recently been subject to regulatory actions to improve its risk management in European workplaces. Analysis of the data obtained within the HBM4EU chromates study provides support both for the implementation of these regulatory actions and for national enforcement programs and may also contribute to the updating of occupational limit values (OELs) and biological limit values for Cr(VI). It also provides useful insights on the contribution of different risk management measures (RMMs) to further reduce the exposure to Cr(VI) and may support the evaluation of applications for authorisation under REACH. Findings on chrome platers’ additional per- and polyfluoroalkyl substances (PFAS) exposure highlight the need to also pay attention to this substance group in the metals sector. A survey performed to evaluate the policy relevance of the HBM4EU chromates study findings supports the usefulness of the study results. According to the responses received from the survey, the HBM4EU chromates study was able to demonstrate the added value of the human biomonitoring (HBM) approach in assessment and management of occupational exposure to Cr(VI). For future occupational studies, we emphasise the need for engagement of policy makers and regulators throughout the whole research process to ensure awareness, relevance and uptake of the results in future policies.Highlights: Potential policy impact of the HBM4EU chromates study is presented and discussed; Surveyed policy makers confirmed policy relevance of biomonitoring results; Study considered to support national enforcement and further lowering of OELs; Added value of HBM in the management of occupational exposure to Cr(VI) was demonstrated; Close co-operation with regulators to support policy uptake is emphasised.Funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries.info:eu-repo/semantics/publishedVersio

The HBM4EU chromates study – Outcomes and impacts on EU policies and occupational health practices

Funding Information: The recently completed EU human biomonitoring initiative (HBM4EU, www.hbm4eu.eu/about-hbm4eu/), was a European Joint Programme that aimed to harmonise the collection and use of biomonitoring data to better understand human exposure to chemicals in the environment, in occupational settings and through the use of consumer products to improve chemical risk assessment and management efforts, and to support policy making (Ganzleben et al., 2017). Within the context of the HBM4EU project several priority substances were selected for investigation based on the most important needs of policy makers and risk assessors, as well as common needs of participating countries and a broad range of other stakeholders including trade unions (Ougier et al., 2021). Many of the priority substances, along with having an important economic role, also pose health risks for workers due to their occupational use. One of the priority substances was hexavalent chromium (Cr(VI)), which was the main focus of the first of a series of three different HBM4EU occupational studies (Santonen et al. 2019a, 2022), the other two being focussed on electronic waste (E-waste) and diisocyanates exposures (Jones et al., 2022; Scheepers et al., 2021). In addition to Cr(VI), it was recognised that in chrome plating activities there may also be exposure to another group of HBM4EU priority chemicals, per- and polyfluoroalkyl substances (PFASs). PFASs, including PFOS (perfluorooctane sulfonate), have been used as mist suppressants in chrome plating baths to prevent the evaporation of Cr(VI) vapours (Blepp et al., 2017; Gluge et al., 2020). Although PFOS has now been largely replaced in the EU, many of its substitutes in chrome plating activities are also PFASs which may cause similar health and environmental concerns.Occupational exposure to Cr(VI) has been associated with an increased risk of lung and sinonasal cancers and is suspected to lead to gastrointestinal tract cancers (den Braver-Sewradj et al., 2021; ECHA 2013; IARC 2012). In addition, it is a common cause of occupational asthma, allergic dermatitis and there is a concern for adverse effects on reproductive health (Sun and Costa 2022). Exposure to Cr(VI) may occur in several occupational activities, e.g., in welding, Cr(VI) electroplating and other surface treatment processes such as paint application and removal of old paint containing Cr(VI) (SCOEL 2017). In order to limit the workers’ exposure to Cr(VI) in the EU, Cr(VI) is currently regulated under both the European regulation (EC 1907/2006) on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) and the EU Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens, mutagens or reprotoxic substances at work (CMRD) (EU 2004). The current binding Occupational Exposure Limit (OEL) set under the EU Directive 2004/37/EC is 10 μg/m3 (8-h time-weighted average (8-h TWA)) until January 17, 2025. After that period, the OEL (8-h TWA) will be reduced to 5 μg/m3. For welding, plasma-cutting processes and similar work processes that generate fumes, there is a derogation with an OEL of 25 μg/m³ (8-h TWA) until January 2025; after that date the OEL (8-h TWA) of 5 μg/m3 will be applicable. France, the Netherlands and Denmark already have stricter limits, with an OEL of 1 μg/m3 (8-h TWA) for Cr(VI) in all uses (Beskæftigelsesministeriet 2020; Ministère du travail, 2012; MinSZW 2016). In the US, the American Conference of Governmental Industrial Hygienists (ACGIH) has published, for inhalable Cr(VI) compounds, a threshold limit value (TLV) of 0.2 μg/m3 (8-h TWA) and a TLV Short-Term Exposure Limit (STEL) of 0.5 μg/m3 (ACGIH 2021). No EU-wide biological limit values (BLVs) for Cr(VI) are available, however some Member States have set BLVs for occupational exposure to Cr(VI), measured as urinary chromium (U–Cr). For example, France and Finland have derived BLVs of 2.5 μg/L and 10 μg/L corresponding to their respective OELs of 1 μg/m3 and 5 μg/m3 for Cr(VI) (ANSES 2017; STM 2020). The German Research Foundation (DFG 2020) has established biological exposure equivalents for carcinogenic substances (EKA values), ranging from 12 to 40 μg/L for U–Cr. These correspond to exposures ranging between 30 and 100 μg/m3 soluble alkaline chromate and/or Cr(VI) containing welding fumes over an 8-h work shift (Bolt and Lewalter 2012). Since these current national BLVs are mainly based on studies from plating workers, they include uncertainties especially concerning their applicability to workplaces other than the electroplating industry. One of the main aims of the HBM4EU chromates study was to provide EU relevant data on the current occupational Cr(VI) exposure to support the regulatory risk assessment and decision-making process. In addition, exposure to PFASs was evaluated in a subset of workers performing chrome plating activities.This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. The project team would like to thank all the companies and workers who participated in the HBM4EU chromates study and all the experts who have contributed to the conduct of the study. Participants of the HBM4EU chromates study workshop and policy questionnaires are also acknowledged. Mr. Jouko Remes and Dr. Kia Gluschkoff (Finnish Institute of Occupational Health) are acknowledged for their assistance with the statistical analyses and figures. Funding Information: This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author's organizations and/or Ministries. Publisher Copyright: © 2022 The AuthorsWithin the EU human biomonitoring initiative (HBM4EU), a targeted, multi-national study on occupational exposure to hexavalent chromium (Cr(VI)) was performed. Cr(VI) is currently regulated in EU under REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) and under occupational safety and health (OSH) legislation. It has recently been subject to regulatory actions to improve its risk management in European workplaces. Analysis of the data obtained within the HBM4EU chromates study provides support both for the implementation of these regulatory actions and for national enforcement programs and may also contribute to the updating of occupational limit values (OELs) and biological limit values for Cr(VI). It also provides useful insights on the contribution of different risk management measures (RMMs) to further reduce the exposure to Cr(VI) and may support the evaluation of applications for authorisation under REACH. Findings on chrome platers’ additional per- and polyfluoroalkyl substances (PFAS) exposure highlight the need to also pay attention to this substance group in the metals sector. A survey performed to evaluate the policy relevance of the HBM4EU chromates study findings supports the usefulness of the study results. According to the responses received from the survey, the HBM4EU chromates study was able to demonstrate the added value of the human biomonitoring (HBM) approach in assessment and management of occupational exposure to Cr(VI). For future occupational studies, we emphasise the need for engagement of policy makers and regulators throughout the whole research process to ensure awareness, relevance and uptake of the results in future policies.publishersversionepub_ahead_of_prin