Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey.

OBJECTIVE: The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized. BACKGROUND: Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction. METHODS: A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA. RESULTS: The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important. CONCLUSIONS: Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools.

Background: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards. Study Design: The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation. Methods: A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project. Results: Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed. Conclusions: Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.

Enhancing SEM positioning precision with a LEGO®-based sample fitting system.

Scanning electron microscopy (SEM) is a precious tool in materials science and morphology sciences, enabling detailed examination of materials at the nanoscale. However, precise and accurate sample repositioning during different observation sessions remains a significant challenge, impacting the quality and repeatability of SEM analyses. This study aimed to develop and evaluate a LEGO®-based sample positioning system for SEM analysis. The system was designed to consistently identify and align features across multiple repositioning cycles, maintain accurate positioning along the z-axis, minimize distortion, and provide repeatable and reliable results. The results indicated a high degree of precision and accuracy in the repositioning process, as evidenced by the minimal displacements, deviations in scaling and shearing, and the highly significant results (p < 0.001) obtained from the analysis of absolute translations and rotations. Moreover, the analyses were consistently replicated across six repetitions, underscoring the reliability of the observed results. While the findings suggest that the LEGO-based sample positioning system is promising for enhancing SEM analyses' quality and repeatability, further studies are needed to optimize the system's design and evaluate its performance in different SEM applications. Ultimately, this study contributes to the ongoing efforts to develop cost-effective, customizable, and accurate solutions for sample positioning in SEM, contributing to the advancement of materials science research and all SEM analysis requiring overtime observations of the same sample. RESEARCH HIGHLIGHTS: This study focused on the development and evaluation of a novel LEGO-based sample positioning system specifically designed for SEM analysis. One of the standout features of this system is its ability to consistently identify and align features across multiple repositioning cycles, showcasing its precision and reliability. To further understand the mechanical aspects of the SEM stage, we employed the Rambold Kontroll comparator, which provided a baseline understanding of its mechanical tolerance. The registration process results were particularly noteworthy, as they revealed high accuracy with minimal displacements. Furthermore, the consistent outcomes observed across multiple repetitions emphasize the reliability and robustness of the methods we employed in this research.

Health and well-being key performance indicators in corporate sustainability disclosure. A review of sustainability reports from a sample of major European companies.

BACKGROUND AND AIM: Health and Well-Being (HWB) measurement represents a key issue for companies in all sectors and a core element of social sustainability, according to the Sustainable Development Goals (SDGs). Despite its importance for companies and in sustainability reporting, the topic has not been investigated yet from a cross-sectoral perspective. Therefore, this research aims to assess if health and well-being are disclosed in sustainability reports of the largest European companies. METHODS: The disclosure of Key Performance Indicators (KPIs) has been investigated and compared according to the main international frameworks of sustainability. The research focused on sustainability reporting from a sample of the 30 largest companies in three methodological steps. First, the inclusion of HWB issues has been analyzed, identifying references to the SDGs and ISO 45001 within the documents. A second level of analysis considered the adoption of the Global Reporting Initiatives (GRI) Standards, with particular attention to Health metrics (GRI:403). The third level of analysis aimed at researching health and well-being performances, linked to specific KPIs from two selected case studies. RESULTS: The review highlighted that all 30 companies generally refer to SDG 3 and SDG 8 in their sustainability reporting while 83%(n=25) of them also apply either Occupational Health and Safety ISO 45001 or Health metrics in GRI Standards; 22 (73%) companies adopted both GRI as the sustainability reporting standard and disclosed the adoption of ISO 45001 management system. Only in two cases, an additional structured framework for HWB is reported highlighting the need for more comprehensive KPIs, especially for employee's well-being. CONCLUSIONS: The study highlighted that health indicators disclosure is generally limited to GRI Standards disclosure. To achieve greater transparency in sustainability reporting, there is a need to further investigate the issue. (www.actabiomedica.it).

Covid-19 emergency management and preparedness in cross-border territories. Collection of experiences, needs and public health strategies in the framework of interreg GESTI.S.CO. project.

BACKGROUND AND AIM: The Covid-19 pandemic highlighted management difficulties in neighboring territories. The aim of the paper is to report the needs of different stakeholders during, before and after Covid-19 emergency with specific regard to challenges faced by public administrators in confined territories. METHODS: In the framework of Interreg GESTI.S.CO. project the study has been designed with two methodological steps: i) a co-design workshop and ii) a web-based survey. The workshop includes both an audience interaction session and focus groups. Then, starting from the focus group results, the survey has been designed with 30 questions and submitted to the 227 municipalities located between Italy and Switzerland to understand the implementation of Public Health strategies in local emergency planning. RESULTS: The interactive session highlighted that most of the critical issues are related to the lack of communication and planning in Public Health policies. The survey highlighted that the local emergency plans rarely integrate a section on health emergencies (30% Italy and 50% Switzerland). Only 20% of the respondents dedicated a section for Covid-19 emergency management. Most of them did not activate initiatives to support mental health. 90% of the municipalities did not cooperate with the neighboring country, but half of them think that it would have been much more useful. The 55% of the Italian respondents are currently updating their emergency plan and will implement it with some Public Health input. CONCLUSIONS: The study provides insights that can support policy makers in improving their strategy in responding to future pandemic. (www.actabiomedica.it).

Green space in hospital built environment. A literature review about therapeutic gardens in acute care healthcare settings before Covid-19.

Background and aim Hospital facilities are one of the most stressful environments and there is evidence that during Covid-19 having outdoor and green spaces helped medical staff and nurses to decrease the stress and anxiety level. Nevertheless, knowledge about the type of green space is limited. The aim of the study is to systematize the existing scientific literature on the topic in a specific time period.     Methods Scopus, Pubmed, and Cochrane library databases have been explored in a systematic way. Following the Prysma diagram 25 studies have been included. Descriptive statistics and content analysis have been performed to highlight green typologies, users and functional area involved, spatial focus, relationship between users and space and vegetation typology. The different topics have been clustered according to Kellert's biophilic framework.     Results Articles reviewed included studies from the 2000 to 2020. The selection led to the analysis of 25 documents; it was significant to understand the major areas of application (pediatrics, ma-ternity, oncology, hospitalization, etc) and forms of green (images, furniture, healing gardens, vegetable gardens, etc).   Conclusions The present review highlight the main characteristics of green space in hospital built environment with specific focus on pre-pandemic situation.

Built environment impact on people with dementia (PwD) health and well-being outcomes: a systematic review of the literature.

BACKGROUND AND AIM: The number of People with Dementia (PwD) is rising worldwide and represents a complex figure because of the changes in the cognitive sphere, altering perceptions of the Built Environment (BE). Even though the role of the built environment in the health and well-being of people it's nowadays well known, few studies analyze and evaluate the impact of specific Architectural Features. To this end, this contribution provides a systematic review that will underline the impacts of BE on the Health and Well-being of PwD and set a matrix of the relationship with measurable outcomes. METHODS: A literature review has been conducted on scientific databases. 40 studies that relate health outcomes and aspects of the built environment have been identified and organized on a comparison matrix that clearly shows the relationships between Architectural Features of BE and Health and Wellbeing Outcome. This matrix allows to identify which are the aspects that can impact on PwD as well as possible lacks. RESULTS: Many aspects appear to be widely explored, such as BPSD or wandering. In addition, significant gaps in the relationship between recognized aspects of the built environment recognized as relevant to the well-being of people with dementia and the real impacts on health outcomes such as the location and personalization of spaces. CONCLUSIONS: This study collected the most recent studies to underline the relationship between BE and dementia, providing a set of outcomes and architectural features that can be analyzed to assess the quality of BE for PwD.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context.

BACKGROUND AND AIM: Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital -Facilities (Mega-hospitals) but their site sustainability is questioned. METHODS: The paper focuses on a comparison -between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for -Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country. RESULTS: This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures. CONCLUSIONS: The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are -suggested.

Evaluation of stakeholder opinion about Long Term Care Facilities for People with Dementia perceived quality: a web-based survey in the Italian context.

BACKGROUND AND AIM: Italy is a country where the percentage of elderly population is very high (23% over 65). The aim of the investigation is to bring out which aspects of the spaces intended to accommodate elderly People with Dementia pathologies should be most present and potentially interested in becoming cornerstones of a new model of Long-Term Care facilities (LTC). METHODS: This research uses a case studies analysis followed by a web based survey as methodological tools. The questions were identified following an analysis of recent European case studies. The survey has been submitted to a panel of stakeholders (users, pratictioner, designer and manager in the healthcare sector). It is articulated in eight items touching on functional, configurational, and perceptual aspects of the LTC. RESULTS: The 210 responses received provided a basis for comparison with the trend lines detected by the case study analysis, establishing continuity on some configurational aspects and providing divergent views for others. The research found a strong need to introduce new service activities and technologies aimed at the care and assistance of guests with dementia. These specific needs often involve the introduction of new spaces and environments or the redefinition of the same, where already present. CONCLUSIONS: The results highlights that a new model of residence must incorporate new technological applications, outdoor spaces, that are perceived significantly by both patients and practitioners, and improve well-being of all users.

Methodologies for Scalable Production of High-Quality Purified Small Extracellular Vesicles from Conditioned Medium.

The development of an extracellular vesicles (EV)-based therapeutic product requires the implementation of reproducible and scalable, purification protocols for clinical-grade EV. Commonly used isolation methods including ultracentrifugation, density gradient centrifugation, size exclusion chromatography, and polymer-based precipitation, faced limitations such as yield efficiency, EV purity, and sample volume. We developed a GMP-compatible method for the scalable production, concentration, and isolation of EV through a strategy involving, tangential flow filtration (TFF). We applied this purification method for the isolation of EV from conditioned medium (CM) of cardiac stromal cells, namely cardiac progenitor cells (CPC) which has been shown to possess potential therapeutical application in heart failure. Conditioned medium collection and EV isolation using TFF demonstrated consistent particle recovery (~1013 particle/mL) enrichment of small/medium-EV subfraction (range size 120-140 nm). EV preparations achieved a 97% reduction of major protein-complex contaminant and showed unaltered biological activity. The protocol describes methods to assess EV identity and purity as well as procedures to perform downstream applications including functional potency assay and quality control tests. The large-scale manufacturing of GMP-grade EV represents a versatile protocol that can be easily applied to different cell sources for wide range of therapeutic areas.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities.

OBJECTIVES: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies. STUDY DESIGN: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed. METHODS: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals. RESULTS: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psychological well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines. CONCLUSIONS: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown.

COVID-19 outbreak imposed rapid and severe public policies that consistently impacted the lifestyle habits and mental health of the general population. Despite vaccination, lockdown restrictions are still considered as potential measures to contrast COVID-19 variants spread in several countries. Recent studies have highlighted the impacts of lockdowns on the population's mental health; however, the role of the indoor housing environment where people spent most of their time has rarely been considered. Data from 8177 undergraduate and graduate students were collected in a large, cross-sectional, web-based survey, submitted to a university in Northern Italy during the first lockdown period from 1 April to 1 May 2020. Logistic regression analysis showed significant associations between moderate and severe depression symptomatology (PHQ-9 scores ≥ 15), and houses with both poor indoor quality and small dimensions (OR = 4.132), either medium dimensions (OR = 3.249) or big dimensions (OR = 3.522). It was also found that, regardless of housing size, poor indoor quality is significantly associated with moderate-severe depressive symptomatology. Further studies are encouraged to explore the long-term impact of built environment parameter modifications on mental health, and therefore support housing and public health policies.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities.

OBJECTIVES: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies. STUDY DESIGN: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed. METHODS: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals. RESULTS: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psycho-logical well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines. CONCLUSIONS: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Covid-19 Massive Vaccination Center Layouts.

BACKGROUND AND AIM OF THE WORK: The rapid evolution of Covid-19 and the availability of numerous vaccines led countries to set up Massive Vaccination campaign in a very short time. Since December 2020, due to the lack of specific guidelines, multidisciplinary groups started to investigate the minimum requirements for Massive Vaccination Centers (MVC). The aim of the paper is to shed light on the process of development of a scalable model for MVC layout design and implementation. METHODS: The methodology included two phases and six steps: 1)Study of MVC with i) acquisition of process data from experimental study on an early set up vaccination hub; ii) review of scientific literature on MVC; iii) review of existing available guidelines and international examples; 2) Design proposal with iv) functional and space requirements collection; v) standard MVC layout design and vi) scalable model definition. RESULTS: The resulting layout is compact, has a good wayfinding and address safety reducing cross-contamination risks. Different vaccine lines have been designed with a central dilution area for process efficiency. Healthcare staff wellbeing is guaranteed by the provision of resting spaces, short distances, and the correct sizing of space for the different activities. To ensure optimal vaccination capacity at the peak of vaccination, a modular and scalable model of different sizes has been designed ranging from 400 to 12000 m2. CONCLUSIONS: The modular layout has been used as basic model in the regional legislation, disclosed with the Deliberation n° XI / 4353 of 24/02/2021. Further research is encouraged to compare different national and international layouts.

Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation.

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Hospital Construction Cost Affecting Their Lifecycle: An Italian Overview.

The need for 24/7 operation, and the increasing requests of high-quality healthcare services contribute to framing healthcare facilities as a complex topic, also due to the changing and challenging environment and huge impact on the community. Due to its complexity, it is difficult to properly estimate the construction cost in a preliminary phase where easy-to-use parameters are often necessary. Therefore, this paper aims to provide an overview of the issue with reference to the Italian context and proposes an estimation framework for analyzing hospital facilities' construction cost. First, contributions from literature reviews and 14 case studies were analyzed to identify specific cost components. Then, a questionnaire was administered to construction companies and experts in the field to obtain data coming from practical and real cases. The results obtained from all of the contributions are an overview of the construction cost components. Starting from the data collected and analyzed, a preliminary estimation tool is proposed to identify the minimum and maximum variation in the cost when programming the construction of a hospital, starting from the feasibility phase or the early design stage. The framework involves different factors, such as the number of beds, complexity, typology, localization, technology degree and the type of maintenance and management techniques. This study explores the several elements that compose the cost of a hospital facility and highlights future developments including maintenance and management costs during hospital facilities' lifecycle.

Functionalized Scintillating Nanotubes for Simultaneous Radio- and Photodynamic Therapy of Cancer.

As a model radio-photodynamic therapy (RPDT) agent, we developed a multicomponent nanomaterial by anchoring conjugated chromophores on the surface of scintillating chrysotile nanotubes. Its ultimate composition makes the system a scintillation-activated photosensitizer for the singlet oxygen production. This nanomaterial shows a remarkable ability to enhance the production of singlet oxygen in an aqueous environment, under X-ray irradiation, boosting its production by almost 1 order of magnitude. Its efficiency as a coadjutant for radiotherapy has been tested in vitro, showing a striking efficacy in enhancing both the prompt cytotoxicity of the ionizing radiation and the long-term cytotoxicity given by radiation-activated apoptosis. Notably, the beneficial activity of the RPDT agent is prominent at low levels of delivered doses comparable to the one employed in clinical treatments. This opens the possibility of effectively reducing the therapy exposure and consequently undesired collateral effects due to prolonged exposure of patients to high-energy radiation.

Shotgun Proteomics of Isolated Urinary Extracellular Vesicles for Investigating Respiratory Impedance in Healthy Preschoolers.

Urine proteomic applications in children suggested their potential in discriminating between healthy subjects from those with respiratory diseases. The aim of the current study was to combine protein fractionation, by urinary extracellular vesicle isolation, and proteomics analysis in order to establish whether different patterns of respiratory impedance in healthy preschoolers can be characterized from a protein fingerprint. Twenty-one 3-5-yr-old healthy children, representative of 66 recruited subjects, were selected: 12 late preterm (LP) and 9 full-term (T) born. Children underwent measurement of respiratory impedance through Forced Oscillation Technique (FOT) and no significant differences between LP and T were found. Unbiased clustering, based on proteomic signatures, stratified three groups of children (A, B, C) with significantly different patterns of respiratory impedance, which was slightly worse in group A than in groups B and C. Six proteins (Tripeptidyl peptidase I (TPP1), Cubilin (CUBN), SerpinA4, SerpinF1, Thy-1 membrane glycoprotein (THY1) and Angiopoietin-related protein 2 (ANGPTL2)) were identified in order to type the membership of subjects to the three groups. The differential levels of the six proteins in groups A, B and C suggest that proteomic-based profiles of urinary fractionated exosomes could represent a link between respiratory impedance and underlying biological profiles in healthy preschool children.

Hospital Architecture in Spain and Italy: Gaps Between Education and Practice.

AIM: The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. BACKGROUND: Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. METHOD: A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. RESULTS: Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners' survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. CONCLUSIONS: Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.

GMP-Grade Methods for Cardiac Progenitor Cells: Cell Bank Production and Quality Control.

Cardiac explant-derived cells (cEDC), also referred as cardiac progenitors cells (CPC) (Barile et al., Cardiovasc Res 103(4):530-541, 2014; Barile et al., Cardiovasc Res 114(7):992-1005, 2018), represent promising candidates for the development of cell-based therapies, a novel and interesting treatment for cardioprotective strategy in heart failure (Kreke et al., Expert Rev Cardiovasc Ther 10(9):1185-1194, 2012). CPC have been tested in a preclinical setting for direct cell transplantation and tissue engineering or as a source for production of extracellular vesicles (EV) (Oh et al., J Cardiol 68(5):361-367, 2016; Barile et al., Eur Heart J 38(18):1372-1379, 2017; Rosen et al., J Am Coll Cardiol 64(9):922-937, 2014). CPC cultured as cardiospheres derived cells went through favorable Phase 1 and 2 studies demonstrating safety and possible efficacy (Makkar et al., Lancet 379(9819):895-904, 2012; Ishigami et al., Circ Res 120(7):1162-1173, 2017; Ishigami et al., Circ Res 116 (4):653-664, 2015; Tarui et al., J Thorac Cardiovasc Surg 150(5):1198-1207, 1208 e1191-1192, 2015). In this context and in view of clinical applications, cells have to be prepared and released according to Good Manufacturing Practices (GMP) (EudraLex-volume 4-good manufacturing practice (GMP) guidelines-Part I-basic requirements for medicinal products. http://ec.europa.eu/health/documents/eudralex/vol-4 ; EudraLex-volume 4-good manufacturing practice (GMP) guidelines-Part IV-guidelines on good manufacturing practices specific to advanced therapy medicinal products. http://ec.europa.eu/health/documents/eudralex/vol-4 ). This chapter describes GMP-grade methods for production and testing of a CPC Master Cell Bank (MCB), consisting of frozen aliquots of cells that may be used either as a therapeutic product or as source for the manufacturing of Exo for clinical trials.The MCB production method has been designed to isolate and expand CPC from human cardiac tissue in xeno-free conditions (Andriolo et al., Front Physiol 9:1169, 2018). The quality control (QC) methods have been implemented to assess the safety (sterility, endotoxin, mycoplasma, cell senescence, tumorigenicity) and identity/potency/purity (cell count and viability, RT-PCR, immunophenotype) of the cells (Andriolo et al., Front Physiol 9:1169, 2018).