The first Italian validation of the Nurse-NursCollaboration Scale

Background and aim of the work: Collaboration between colleagues is an essential element of clinical nursing care because it helps to ensure patient safety. This study aimed to evaluate the psychometric properties of the Italian version of the Nurse-Nurse Collaboration Scale (NNCS). The secondary goal of this study was to assess the degree of collaboration between nurses in Italy. Methods: First, the cultural adaptation of the NNCS tool was performed. The face and content validity of the tool were assessed through the involvement of nursing experts. To test construct validity, a cross-sectional web-based study was conducted on a sample of 362 clinical nurses. Results: The Italian version of the NNCS was composed of 23 items distributed across the original five domains. Ten items were removed from the original instrument because they showed several cross-loadings on more than one factor. The five-dimensional model showed an adequate model goodness of fit (RMSEA=0.075, CFI=0.883, SRMR=0.072). The NNCS dimension with the highest average score was Professionalism (M=3.10 ± 0.45), while Conflict Management (M=2.14 ± 0.47) exhibited the lowest score. Conclusions: The Italian version of the NNCS is a valid and reliable tool. More effort should be made to ensure the proper management of conflicts in healthcare environments

Supporting Decision Making for Sustainable Nanotechnology

Understanding how stakeholders manage risks associated with nanomaterials is a key input to the design of strategies and tools to achieve safe and sustainable nanomanufacturing. The paper presents some results of a study aiming firstly to inform the development of a software decision support tool. Further, we seek also to understand existing tools used by stakeholders as a source of capabilities and potential adaptation into decision support framework and tools. Central research questions of this study are: How is collective decision-making on risk management and sustainable nanomaterials organised? Which aspects are taken into account in this collective decision-making? And what role can a decision support tool play in such decision-making? The paper analyses 13 responses to a questionnaire survey held among participants in a meeting in October 2013 and a series of 27 semi-structured telephone interviews conducted from January until April 2014 with decision-makers from mainly European industry and regulators involved in risk management and sustainable manufacturing of nanomaterials. Findings from the study on the social organisation of collective decision-making, aspects taken into account in decisions and potential role of decision support tools are presented.Understanding how stakeholders manage risks associated with nanomaterials is a key input to the design of strategies and tools to achieve safe and sustainable nanomanufacturing. The paper presents some results of a study aiming firstly to inform the development of a software decision support tool. Further, we seek also to understand existing tools used by stakeholders as a source of capabilities and potential adaptation into decision support framework and tools. Central research questions of this study are: How is collective decision-making on risk management and sustainable nanomaterials organised? Which aspects are taken into account in this collective decision-making? And what role can a decision support tool play in such decision-making? The paper analyses 13 responses to a questionnaire survey held among participants in a meeting in October 2013 and a series of 27 semi-structured telephone interviews conducted from January until April 2014 with decision-makers from mainly European industry and regulators involved in risk management and sustainable manufacturing of nanomaterials. Findings from the study on the social organisation of collective decision-making, aspects taken into account in decisions and potential role of decision support tools are presented

Identification of the safe(r) by design alternatives for nanosilver-enabled wound dressings

The use of silver nanoparticles (NPs) in medical devices is constantly increasing due to their excellent antimicrobial properties. In wound dressings, Ag NPs are commonly added in large excess to exert a long-term and constant antimicrobial effect, provoking an instantaneous release of Ag ions during their use or the persistence of unused NPs in the wound dressing that can cause a release of Ag during the end-of-life of the product. For this reason, a Safe-by-Design procedure has been developed to reduce potential environmental risks while optimizing functionality and costs of wound dressings containing Ag NPs. The SbD procedure is based on ad-hoc criteria (e.g., mechanical strength, antibacterial effect, leaching of Ag from the product immersed in environmental media) and permits to identify the best one among five pre-market alternatives. A ranking of the SbD alternatives was obtained and the safer solution was selected based on the selected SbD criteria. The SbD framework was also applied to commercial wound dressings to compare the SbD alternatives with products already on the market. The iterative procedure permitted to exclude one of the alternatives (based on its low mechanical strength) and proved to be an effective approach that can be replicated to support the ranking, prioritisation, and selection of the most promising options early in the innovation process of nano-enabled medical devices as well as to encourage the production of medical devices safer for the environment

Occupational risk of nano-biomaterials: Assessment of nano-enabled magnetite contrast agent using the BIORIMA Decision Support System

The assessment of the safety of nano-biomedical products for patients is an essential prerequisite for their market authorization. However, it is also required to ensure the safety of the workers who may be unintentionally exposed to the nano-biomaterials (NBMs) in these medical applications during their synthesis, formulation into products and end-of-life processing and also of the medical professionals (e.g., nurses, doctors, dentists) using the products for treating patients. There is only a handful of workplace risk assessments focussing on NBMs used in medical applications. Our goal is to contribute to increasing the knowledge in this area by assessing the occupational risks of magnetite (Fe3O4) nanoparticles coated with PLGA-b-PEG-COOH used as contrast agent in magnetic resonance imaging (MRI) by applying the software-based Decision Support System (DSS) which was developed in the EU H2020 project BIORIMA. The occupational risk assessment was performed according to regulatory requirements and using state-of-the-art models for hazard and exposure assessment, which are part of the DSS. Exposure scenarios for each life cycle stage were developed using data from literature, inputs from partnering industries and results of a questionnaire distributed to healthcare professionals, i.e., physicians, nurses, technicians working with contrast agents for MRI. Exposure concentrations were obtained either from predictive exposure models or monitoring campaigns designed specifically for this study. Derived No-Effect Levels (DNELs) were calculated by means of the APROBA tool starting from in vivo hazard data from literature. The exposure estimates/measurements and the DNELs were used to perform probabilistic risk characterisation for the formulated exposure scenarios, including uncertainty analysis. The obtained results revealed negligible risks for workers along the life cycle of magnetite NBMs used as contrast agent for the diagnosis of tumour cells in all exposure scenarios except in one when risk is considered acceptable after the adoption of specific risk management measures. The study also demonstrated the added value of using the BIORIMA DSS for quantification and communication of occupational risks of nano-biomedical applications and the associated uncertainties

Morpho-chemical characterization of individual ancient starches retrieved on ground stone tools from Palaeolithic sites in the Pontic steppe

Despite the extensive literature on the retrieval of digestible starches from archaeological contexts, there are still signifcant concerns regarding their genuine origin and durability. Here, we propose a multi-analytical strategy to identify the authenticity of ancient starches retrieved from macrolithic tools excavated at Upper Paleolithic sites in the Pontic steppe. This strategy integrates the morphological discrimination of starches through optical microscopy and scanning electron microscopy with single starch chemo-profling using Fourier transform infrared imaging and microscopy. We obtained evidence of aging and biomineralization in the use-related starches from Palaeolithic sites, providing a methodology to establish their ancient origin, assess their preservation status, and attempt their identifcation. The pivotal application of this multidisciplinar approach demonstrates that the macrolithic tools, from which starches were dislodged, were used for foodprocessing across the Pontic Steppe around 40,000 years ago during the earliest colonization of Eurasia by Homo sapien

Impact on Prehospital Delay of a Stroke Preparedness Campaign: A SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial)

Background and Purpose—Public campaigns to increase stroke preparedness have been tested in different contexts, showing contradictory results. We evaluated the effectiveness of a stroke campaign, designed specifically for the Italian population in reducing prehospital delay. Methods—According to an SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial) design, the campaign was launched in 4 provinces in the northern part of the region Emilia Romagna at 3-month intervals in randomized sequence. The units of analysis were the patients admitted to hospital, with stroke and transient ischemic attack, over a time period of 15 months, beginning 3 months before the intervention was launched in the first province to allow for baseline data collection. The proportion of early arrivals (within 2 hours of symptom onset) was the primary outcome. Thrombolysis rate and some behavioral end points were the secondary outcomes. Data were analyzed using a fixed-effect model, adjusting for cluster and time trends. Results—We enrolled 1622 patients, 912 exposed and 710 nonexposed to the campaign. The proportion of early access was nonsignificantly lower in exposed patients (354 [38.8%] versus 315 [44.4%]; adjusted odds ratio, 0.81; 95% confidence interval, 0.60–1.08; P=0.15). As for secondary end points, an increase was found for stroke recognition, which approximated but did not reach statistical significance (P=0.07). Conclusions—Our campaign was not effective in reducing prehospital delay. Even if some limitations of the intervention, mainly in terms of duration, are taken into account, our study demonstrates that new communication strategies should be tested before large-scale implementation. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01881152

Safe-by-design assessment of an SiO2@ZnO multi-component nanomaterial used in construction

Safety aspects of chemicals/materials are transversal in all sustainability dimensions, representing a pillar at the early innovation stages of the European Commission's "safe and sustainable by design" (SSbD) framework for chemicals and materials. The first three of the five SSbD framework steps cover different safety aspects, namely, hazard assessment based on intrinsic properties (step 1), occupational health and safety (including exposure) assessment during the production/processing phase (step 2) and exposure in the final application phase (step 3). The goal of this work was to identify a set of characterization tools/procedures to support the operationalization of the first three safety steps in multi-component nanomaterials (MCNMs), applying the findings to an SiO2 core-ZnO shell MCNM. The safety of this MCNM, which is used as an additive to silicate/calcium hydroxide mortar to improve air quality through photocatalytic NOx removal, was investigated from different perspectives along its value chain. Existing and newly generated data on its hazard profile were collected, the exposure of workers during its synthesis was assessed, and potential exposure to hazardous substances during its final application phase was investigated. In step 1, physico-chemical properties, hazard classification and cytotoxicity assays were considered. In step 2, a three-tiered established methodology for evaluating occupational exposure assessment was performed. Lastly, in step 3, the release of inorganic substances from MCNM-based mortars in the final application phase was investigated. Safety assessment according to the SSbD framework was performed by selecting tools and procedures suitable for application in the early innovation stage, resulting in a preliminary hazard assessment of MCNMs and a suggestion for redesigning a step in the process

Risk Governance of Emerging Technologies Demonstrated in Terms of its Applicability to Nanomaterials

Nanotechnologies have reached maturity and market penetration that require nano-specific changes in legislation and harmonization among legislation domains, such as the amendments to REACH for nanomaterials (NMs) which came into force in 2020. Thus, an assessment of the components and regulatory boundaries of NMs risk governance is timely, alongside related methods and tools, as part of the global efforts to optimise nanosafety and integrate it into product design processes, via Safe(r)-by-Design (SbD) concepts. This paper provides an overview of the state-of-the-art regarding risk governance of NMs and lays out the theoretical basis for the development and implementation of an effective, trustworthy and transparent risk governance framework for NMs. The proposed framework enables continuous integration of the evolving state of the science, leverages best practice from contiguous disciplines and facilitates responsive re-thinking of nanosafety governance to meet future needs. To achieve and operationalise such framework, a science-based Risk Governance Council (RGC) for NMs is being developed. The framework will provide a toolkit for independent NMs' risk governance and integrates needs and views of stakeholders. An extension of this framework to relevant advanced materials and emerging technologies is also envisaged, in view of future foundations of risk research in Europe and globally

Risk Governance of Emerging Technologies Demonstrated in Terms of its Applicability to Nanomaterials

Nanotechnologies have reached maturity and market penetration that require nano-specific changes in legislation and harmonization among legislation domains, such as the amendments to REACH for nanomaterials (NMs) which came into force in 2020. Thus, an assessment of the components and regulatory boundaries of NMs risk governance is timely, alongside related methods and tools, as part of the global efforts to optimise nanosafety and integrate it into product design processes, via Safe(r)-by-Design (SbD) concepts. This paper provides an overview of the state-of-the-art regarding risk governance of NMs and lays out the theoretical basis for the development and implementation of an effective, trustworthy and transparent risk governance framework for NMs. The proposed framework enables continuous integration of the evolving state of the science, leverages best practice from contiguous disciplines and facilitates responsive re-thinking of nanosafety governance to meet future needs. To achieve and operationalise such framework, a science-based Risk Governance Council (RGC) for NMs is being developed. The framework will provide a toolkit for independent NMs' risk governance and integrates needs and views of stakeholders. An extension of this framework to relevant advanced materials and emerging technologies is also envisaged, in view of future foundations of risk research in Europe and globally