A. Pena-Fernandez

Establishing the importance of human health risk assessment for metals and metalloids in urban environments.

Rapid development, industrialisation, and urbanisation have resulted in serious contamination of soil by metals and metalloids from anthropogenic sources in many areas of the world, either directly or indirectly. Exponential urban and economic development has resulted in human populations settling in urban areas and as a result being exposed to these pollutants. Depending on the nature of the contaminant, contaminated urban soils can have a deleterious effect on the health of exposed populations and may require decontamination, recovery, remediation and restoration. Therefore, human health risk assessments in urban environments are very important. In the case of Spain, there are few studies regarding risk assessment of trace elements in urban soils, and those that exist have been derived mainly from areas potentially exposed to industrial contamination or in the vicinity of point pollution. The present study analysed Al, As, Be, Cd, Cr, Cu, Hg, Mn, Ni, Pb, Sn, Ti, Tl, V and Zn soil concentrations in and around the city of Alcalá de Henares (35 km NE of Madrid). Soil samples were collected in public parks and recreation areas within the city and in an industrial area on the periphery of the city. From these results, an assessment of the health risk for the population was performed following the methodology described by the US EPA (1989). In general, it was observed that there could be a potential increased risk of developing cancer over a lifetime from exposure to arsenic (As) through ingestion of the soils studied (oral intake), as well as an increased risk of cancer due to inhalation of chromium (Cr) present in re-suspended soils from the industrial area. Our group has previously reported (Granero and Domingo, 2002; Peña-Fernández et al., 2003) that there was an increased risk of developing cancer following exposure to As in the same soils in a previous study. Therefore, it is necessary to reduce the levels of contaminants in these soils, especially As and Cr as these have been found to exceed safe levels for human health.

Monitoring lead in hair of children and adolescents of Alcalá de Henares, Spain. A study by gender and residential areas

In recent years there has been an increased interest from the European Union (EU) in the development of large Human Bio-monitoring (HBM) studies across Europe, especially biomonitoring toxic metals. In Spain, most studies using hair as a biomarker have been conducted to determine occupational or industrial exposures, and have involved adult populations. Few studies have involved adolescents and children, despite these groups being sensitive to environmental contamination and pollutants. Therefore, the objective of the present study was to determine the degree of lead exposure in children and adolescents residing in Alcalá de Henares, Spain. Lead poisoning is the number one toxicological threat in the environment. So, lead (Pb) was selected as it is a persistent environmental contaminant, is measureable and is also a neurotoxin that can affect brain development. The city of Alcalá de Henares was divided into four zones to determine the influence of residence area on Pb levels. A range of other variables including age and gender were also considered within the study. The study comprised 115 children (6-9 years old) and 96 adolescents (13-16 years old). There was a significant difference between the levels of Pb in the hair of adolescents, for different gender and area of residence (p<0.001 and p<0.01 respectively). There was no significant difference in the Pb levels in hair of children, for different gender or area of the city. The levels of Pb were significantly (p<0.001) elevated in children compared to adolescents (1.48 vs. 0.70 μg/g), and there was a significant difference in Pb levels in male and female adolescent hair (0.53 vs. 0.77 μg/g) (p<0.001). The association observed between areas of residence and the Pb level in hair of the adolescent group could be mainly attributed to dietary habits and/or socioeconomic status.

Annual and seasonal variability of metals and metalloids in urban and industrial soils in Alcalá de Henares (Spain).

Contamination of urban and industrial soils with trace metals has been recognized as a major concern at local, regional and global levels due to their implication on human health. In this study, concentrations of aluminum (Al), arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), manganese (Mn), nickel (Ni), lead (Pb), tin (Sn), thallium (Tl), vanadium (V) and zinc (Zn) were determined in soil samples collected in Alcalá de Henares (Madrid, Spain) in order to evaluate the annual and seasonal variation in their levels. The results show that the soils of the industrial area have higher metals concentrations than the urban area. Principal component analysis (PCA) revealed that the two principal sources of trace metal contamination, especially Cd, Cu, Pb, and Zn in the urban soils of Alcalá can be attributed to traffic emissions, while As, Ni and Be primarily originated from industrial discharges. The seasonal variation analysis has revealed that the emission sources in the industrial area remain constant with time. However, in urban areas, both emissions and emission pathways significantly increase over time due to ongoing development. Currently, there is no hypothesis that explains the small seasonal fluctuations of trace metals in soils, since there are many factors affecting this. Owing to the fact that urban environments are becoming the human habitat, it would therefore be advisable to monitor metals and metalloids in urban soils because of the potential risks to human health.

Silicic Acid and Beer Consumption Reverses the Metal Imbalance and the Prooxidant Status Induced by Aluminum Nitrate in Mouse Brain

BACKGROUND Emerging evidence suggests that by affecting mineral balance, aluminum (Al) may enhance some events associated with neurodegenerative diseases. AIM To examine the effect of Al(NO3)3 exposure on brain Al, cooper (Cu), iron (Fe), magnesium (Mg), manganese (Mn), silicon (Si), and zinc (Zn) levels, and the metal-change implication in brain oxidant and inflammatory status. METHODS Four groups of six-week-old male NMRI mice were treated for three months: i) controls, administrated with deionized water; ii) Al, which received Al(NO3)3; iii) Al+silicic acid, which were given Al(NO3)3 plus silicic acid; and iv) Al+beer, which received Al(NO3)3 plus beer. RESULTS Brain Al and TBARS levels and TNFα and GPx expressions increased, while Cu, Mn, and Zn levels, and catalase and CuZn-SOD expression decreased (at least, p < 0.05) in Al versus control animals. Al, Si, and TBARS levels and TNFα expression decreased (p < 0.05) in Al+silicic acid and Al+beer specimens while Cu, Mn, and Zn levels and antioxidant expression increased versus the Al group. Brain Al levels correlated negatively with those of Cu, Fe, Mn, and Zn, and catalase, CuZn-SOD, and GPx enzyme expressions but positively with Si and TBARS levels and TNFα expression. Two components of the principal component analysis (PCA) explained 71.2% of total data variance (p < 0.001). PCA connected the pro-oxidant markers with brain Al content, while brain Zn and Cu levels were closer to antioxidant enzyme expression. CONCLUSION Administration of Al(NO3)3 induced metal imbalance, inflammation, and antioxidant status impairment in the brain. Those effects were blocked to a significant extent by silicic acid and beer administration.

Levels of rare earth elements in hair from a group of young Spanish adults (aged 20-24 years).

The rapid agricultural, medical and industrial development is occurring on a global scale and bringing with emerging environmental threats for humans. Contamination by rare earth elements (REE) has emerged as a public health concern due to their numerous applications in the current industry. However, little is known about their toxicological effects despite they can accumulate in different organs including brain and bone. To determine the exposure to these contaminants in a young Spanish population, scalp hair samples were collected in 37 young adults (20 to 24 years-old; 28 female and 9 male) from different towns in the Community of Madrid (Spain). Despite being controversial, human hair could be an appropriate tool to determine environmental exposure to inorganic metal contaminants and to estimate the chemical burden in the individual. Lanthanum (La), cerium (Ce), praseodymium (Pr), erbium (Er) and gadolinium (Gd) were analysed in these samples by ICP-MS following appropriate methodologies. The limits of detection were (in ng/g): La (1.87), Ce (4.29), Pr (0.47), Er (0.06) and Gd (0.24 ng/g). Gd was detected only in one of the monitored samples (2.66 ng/g). The concentrations were as follow (median and percentiles are provided in ng/g): La 5.30 (4.22, 7.13), Ce 11.18 (8.97, 15.45), Pr 1.28 (1.04, 1.72) and Er 0.19 (0.14, 0.28). In general, the presence of these metals in the Spanish group’s hair monitored were lower than those reported in environmentally exposed groups, which may indicate that the studied group would have a low exposure to REE. None of these elements showed influence due to sex, although slightly higher levels were observed for La (5.57 vs. 5.17 ng/g), Pr (1.40 vs. 1.27 ng/g), Nd (2.48 vs. 2.29 ng/g) and Er (0.21 vs. 0.19 ng/g) in men’s hair and in women’s hair for Ce (11.58 vs 10.30 ng/g). Despite is unclear, our results would be in agreement with those studies that have suggested that men may be more sensitive to REE than women.

Interest shown by medical students at University of San Pablo CEU (Spain) regarding prevention and response to outbreaks of infection

The release of biological hazards during biological incidents, bioterrorism or outbreaks of infection has shown to represent a significant challenge for healthcare professionals as it can involve significant numbers of patients and represent a global public health threat. Healthcare educators should provide students with the necessary skills in medical preparedness and response to these incidents to protect the public. However, this is not standardised in the medical curriculum. An innovative teaching group at De Montfort University (DMU, UK) in collaboration with first responders that worked during the 2014-2016 Ebola outbreak in a Public Health England (PHE) mobile laboratory in Sierra Leone, have developed different, novel teaching training sessions to provide health science students with the necessary skills to respond to these events. We have tested the training sessions with students from three different undergraduate (BSc Biomedical and Medical Science) and postgraduate (MSc Advanced Biomedical Science) human health programmes at DMU. In general, these sessions were shown to be successful in providing students with basic skills to respond to minor biological incidents (Peña-Fernández et al., 2017) [1], although we do not know if these could be adopted to develop standardized curricula across any human health degree in the European Union (EU). Therefore, the purpose of this work was twofold: a) to assess the effectiveness of the specialised training session that covers the medical response to protect public health with medical students; and b) to determine the effectiveness of the training session, initially developed in England, in a non-English EU university. To meet these objectives, we have simplified this specialised training and delivered it to final year students of the Medicine degree at the University of San Pablo CEU (USP-CEU, Spain) during an Eramus+ mobility grant for academics in April 2017. The two hour training provided consisted of developing a complete intervention programme to deal with an outbreak of Crimean-Congo haemorrhagic fever (CCFH) virus following the steps of evidence-based public health. CCFH is a haemorrhagic fever virus causing devastating disease symptoms that result in intense and prolonged suffering in humans and has become an increasing global health concern. This paper will describe the teaching resources used and a comprehensive analysis of students’ feedback to this training. Briefly: the specific questionnaire used has shown high levels of engagement and satisfaction [100% (31.2% agreed; 68.8% strongly agreed)] with the USP-CEU medical students. Despite its short duration, this training would be successful in providing medical students with the necessary skills to respond to a biological event. Thus, 100% (31.2% agreed; 68.8% strongly agreed) of these students reported that they learnt how to establish some public health interventions to protect humans in the aftermath of an outbreak of infection. Moreover, all USP-CEU responders have described that they gained appropriate knowledge of public health prevention and preparedness against these events (37.5% agreed; 62.5 strongly agreed). Finally, the Erasmus+ mobility grant for academics has been shown to be a relevant tool and resource to strengthen curricula development and validation in higher education.

Human biomonitoring research at De Montfort University: school and university participants' recruitment experience

Involving teachers in scientific research can increase schoolchildren’s interest in studying science from an early stage which is critical to increase the numbers of high-school students studying scientific subjects. This will impact on the number of students enrolled in university science degrees to satisfy many basic human needs. A group of academics at De Montfort University (DMU, UK) have involved the Ravenhurst Primary School (RPS) in biomedical research, specifically a human biomonitoring (HBM) study involving schoolchildren (aged 6-9 years) and university students (aged 18-22 years) in Leicester (UK) to determine their nutritional status and exposure to metals. We have adopted a school-based approach to recruit participants from both educational arenas following the recommendations for executing HBM studies in Europe [1] with some modifications. Permission from the school authorities was requested after gaining ethical approval from the DMU Research Ethics Committee (Ref. 1674). Parental/student consent was obtained by invitation and appointment letter, with the project details and ethical and data protection aspects written in simple language. Appropriately developed flyers, posters and information leaflets for each audience were also used to enhance the recruitment processes. Scheduling and facilitating flexible face-to-face appointments was critical for collecting the human samples needed for the project (urine and scalp hair) as well as comprehensive details about participants’ diet and anthropometric measurements. The involvement of teachers and lecturers in conjunction with a registered general nurse (school nursing) was of paramount importance for achieving these goals, as they were encouraging participation throughout the process. During the appointments, parents and participants were debriefed in more detail about the project and the relevance of performing HBM to improve health in the community. The school-based approach achieved the following results: a) the recruitment of a relevant number of participants (12 schoolchildren and 111 university students); b) the provision of a satisfying educational experience for parents, teachers/academics and participants in both educational arenas; c) the involvement of school-children in scientific research; d) the acquisition of awareness of the impact of environmental contamination by metals on human health; e) informing participants about their diets and body composition (e.g. percentage of body fat) promoting the necessity of adopting a healthy diet and lifestyle. In conclusion, the project was successful in involving School teachers, University lecturers, schoolchildren, University students and community health workers in a research project. It provided an opportunity for educational development, promote staff motivation and students’ interest and involvement in scientific research. Teachers updated their biomedical knowledge and skills by participating in this research and learnt new methods to engage schoolchildren (by promoting healthy lifestyles, protect the environment, etc.). This could help increase students’ interest in studying science subjects at University and motivate them to embark on a future scientific career. Finally, the UK education system should do more to engage schools and teachers in performing scientific research and thereby make the scientific curriculum more practical that will facilitate students’ learning and engagement.

Interventions to enhance the teaching of toxicology at a UK University

Following the recent communication from the European Societies of Toxicology (EUROTOX) advising that toxicology training and expertise is being eroded in the European Union, we have reviewed the teaching status of this subject in all the bioscience undergraduate courses offered at De Montfort University (DMU, UK). The courses reviewed were: Biomedical Science, Health and Wellbeing in Society, Speech and Language Therapy, Medical Science, Pharmaceutical and Cosmetic Science, Forensic Science and Pharmacy. None of these courses dedicate a complete module to the study of toxicology although they teach some aspects of toxicology following the subject-specific threshold standards described by the UK Quality Assurance Agency for Higher Education. Similar results are found in other UK Universities, although a comprehensive study on the status of toxicology teaching is needed. We have not found any undergraduate courses currently offered in the UK that contained the word “toxicology” in their title. These results are in agreement with EUROTOX, which indicated that toxicology has been generally integrated into other bioscience disciplines and is mainly offered as part of a taught postgraduate degree programme in Europe. Owing to these observations, our teaching group is performing different strategies to enhance the teaching of toxicology at DMU as we consider that the learning of this science is critically important to enable future health professionals to protect human health. These strategies included the development of specialised teaching/workshop sessions in toxicology that can be easily included in any undergraduate bioscience module. Thus, during 2016/17 we collected comprehensive feedback (during an Erasmus+ mobility grant for academics) from human health students about their views on the teaching of toxicology and one of the specialised workshops in a programme that does not offer a module in toxicology (BMedSci Medical Science, DMU) and one that does (MPharm. Pharmacy, University of San Pablo CEU, Spain). A high proportion of the students consulted requested more teaching of toxicology or the introduction of more specialised toxicology in their programmes. Thus, 85% of second year BMedSci students indicated that they would like to receive more toxicology training. Also, 42.9% (57.1% neither agree nor disagree) of fourth year MPharm. Students suggested the incorporation of specialised environmental toxicology workshops within their course and all of them considered the environmental toxicology training relevant to their general toxicology module. Other strategies implemented include the enhancement of research in toxicology in our university by offering final projects on these topics to undergraduate and postgraduate students, as well as completion of PhDs. Finally, DMU has recently recruited two toxicologists as academic staff, allowing us to promote the teaching/research of toxicology as well as exploring the possibility of developing postgraduate content for the teaching of toxicology. More efforts should be considered to enhance the teaching of this subject in any bioscience programme, as the current status of toxicology in the UK has been eroded.

Two years' analysis of environmental recovery training for biological incidents

Environmental recovery in the aftermath of a biological incident is one of the key areas to consider when tailoring a response to protect human health and minimise the spread of the biological agent(s) involved. However, recent studies have highlighted general national and international emergency weaknesses including a lack of preparedness in health care professionals and emergency responders to tackle these events. We undertook a web-based, non-systematic search for biological response training in human health undergraduate programmes in the UK, by using the GoogleTM search engine. To the best of our knowledge, there are no undergraduate courses in the UK that directly address this topic. Only a few postgraduate programmes present some information about responding to biological incidents but they do not cover the different phases of a biological incident response, which are: preparedness and situation assessment; exposure assessment; acute health effects; long term health effects; and recovery phase. In order to develop appropriate training, academics from De Montfort University (DMU, Leicester, UK) and the University of Alcalá (Spain) in collaboration with first responders (biomedical scientists) to the 2014-16 Ebola outbreak in Sierra Leone, have developed specific training for undergraduate human health degree students to respond to biological incidents. We have created basic competences to develop this training and distributed them into six domains following the recommendations of the European Commission for medical responders to CBRN emergencies [1]: identification of the risk and risk analysis; toxicological effect of biological agents; planning and organisation of an intervention programme; environmental planning; communication and information management; safety and personal protective equipment; societal and ethical reflections. Following the basic competences created, we developed different training sessions with two components, theoretical (lectures and seminars) and practical (research-led workshop), to cover each of the different phases of an appropriate response to any biological incident. The specific training that covers the recovery phase has been delivered to postgraduate students from the MSc programme in Advanced Biomedical Science at DMU since 2016/17 due to the more manageable student number, time available to deliver the training and greater background knowledge of the class. The analysis of the feedback provided by the first cohort of students indicated high levels of engagement and interest in this training session. We performed some minor modifications following the students’ feedback and delivered it this academic course 2017/18 (n=9) to gain more information about its effectiveness in facilitating the specific basic competences covered in this training including the resources used to tailor a recovery response to the case scenario proposed (an outbreak due to Cyclospora spp.) such as the UK Recovery Handbook for Biological Incidents (UKRHBI; PHE, 2015 [2]). All students were satisfied with this training and all highlighted that the tools used aided their learning about environmental recovery (33.3% agreed; 66.7% strongly agreed). All participants indicated that the UKRHBI was an appropriate resource for tailoring a recovery response. Finally, students indicated that they would have liked to have more time to develop a response to the case scenario proposed (the workshop was 2 hours long).

Focus group to create a virtual case study model unit for the DMU e-Parasitology.

De Montfort University (DMU, Leicester, UK) is leading a teaching innovation project for the creation of a complete package for teaching and learning human parasitology in collaboration with the Spanish universities: San Pablo CEU and Miguel Hernández, and practicing Biomedical Scientists from the UK National Health Service. The DMU e-Parasitology package will be freely available on the DMU website (http://parasitology.dmu.ac.uk/) late in 2018 and present three modules: a theoretical unit for the study of medical parasitic diseases; a virtual laboratory and microscope sections with a complete collection of clinical slides for the study of these major diseases. To provide the user of this novel package with a holistic and complete experience for the learning of medical parasitology we have started the development of a fourth section, which will hold highly interactive virtual case studies in which the user will be provided with a medical history and different clinical slides to identify the parasites and their structures. The user will need to reflect and critically think to suggest potential diagnoses, additional diagnostic techniques, treatment and prevention techniques for that parasitic disease. A first virtual case study has been created in the DMU e-Parasitology here: http://parasitology.dmu.ac.uk/learn/ case_studies/cs1/story_html5.html, as described in Peña-Fernández et al. (2018) [1]. The degree of difficulty is medium-high, so a background in parasitology is needed to resolve it. Comprehensive student feedback is being collected to improve this case study, which will be used as a model unit to develop future case studies for this section. To determine the feasibility of this case study to train postgraduate students, DMU students attending the MSc Advanced Biomedical Science have completed the case study during a workshop session specially delivered this academic course 2017/18 (n=9). We collected the following results: 100% students indicated that the eParasitology is interactive (71.4% agreed, 28.57 strongly agreed), and the case-study presented was appropriate for their studies (57.1% agreed, 42.9% strongly agreed). In relation to the content, all students highlighted that it was relevant for their studies (42.9% agreed, 57.1% strongly agreed), and indicated that the exercises presented were easy to understand (71.43% agreed, 28.57% strongly agreed). In the freeopen questions available in the questionnaire, postgraduate students demanded more case studies and mini-formative assessments within the theoretical units that they reviewed to answer the virtual case study (free-living amoebas and Entamoeba histolytica). Finally, they suggested the provision of the correct answers throughout the case study instead of at the end.