Behaviour of synthetic musk fragrances in freshwaters: occurrence, relations with environmental parameters, and preliminary risk assessment.

The aims of this study were to investigate the presence, possible sources, and potential ecological risks of synthetic musk fragrances in freshwaters and sediments of the main tributaries of a deep subalpine lake in Northern Italy. The total musk concentrations ranged from few ng L-1 up to values > 500 ng L-1, depending on river characteristics: water flow and the presence of wastewater effluents proved to be the main factors affecting fragrance concentrations. The water flow may indeed dilute fragrance input mainly deriving from treated wastewaters. Good correlations (determination coefficients > 0.60) between synthetic fragrances concentrations and parameters related to anthropogenic impacts confirmed this hypothesis: synthetic fragrances were mainly detected in most polluted rivers crossing urbanized areas. Sediment analysis highlighted accumulation of fragrances in this matrix. Concentrations of synthetic fragrances up to 329 ng g-1 organic carbon were measured in sediments of the most contaminated rivers Boesio and Bardello, which also show the highest nutrient content. The preliminary environmental risk assessment revealed that present levels of synthetic musk fragrances do not pose any risk to the studied environmental compartments. However, a probable medium risk level was evidenced during the dry season in the most contaminated rivers Boesio and Bardello. For these reasons, small rivers draining urbanized watersheds and affected by wastewater effluents should be considered synthetic musk contamination hotspots that warrant further research.

Integrated Exposure and Algal Ecotoxicological Assessments of Effluents from Secondary and Advanced-Tertiary Wastewater-Treatment Plants.

The great concern over the environmental impact of wastewaters has led to the designing of advanced treatment processes to upgrade conventional treatment plants and achieve a significant reduction of contaminants in receiving waters. In the present study we combined chemical and ecotoxicological analyses, aiming to evaluate the reduction of toxicity effects associated with the removal of micropollutants and to define the contribution of the detected compounds to the overall toxicity of the mixtures in a series of wastewater effluents collected from a secondary treatment (OUT 2) and from a tertiary activated carbon treatment (OUT 3) plant. The target compounds were selected after a screening procedure among pharmaceuticals, musk fragrances, and trace metals. The classical algal growth inhibition test was conducted on the original effluent samples and on different fractions obtained by solid-phase extraction (SPE) treatment. A good accordance was found between the removal of toxicity (30%-80%) and organic compounds (70%-80%) after the tertiary treatment, suggesting its high efficiency to improve the wastewater quality. The discrepancy between the contribution to the overall toxicity of the nonadsorbable compounds (i.e., inorganic or very polar organic compounds) as experimentally measured by the SPE bioassays (18%-76%) and calculated by the concentration addition approach (>97%) could be mitigated by including the bioavailability correction in metal-toxicity modeling of wastewater mixtures. For the organic compounds, the toxic equivalency method enabled us to quantify the portion of toxicity explained by the detected chemicals in both OUT 2 (82%-104%) and OUT 3 (5%-57%), validating the selection of the target molecules. The applied integrating approach could be implemented by the inclusion of both additional target chemicals and toxicity endpoints. Environ Toxicol Chem 2022;41:2404-2419. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Twenty-year sediment contamination trends in some tributaries of Lake Maggiore (Northern Italy): relation with anthropogenic factors.

Lake tributaries collect contaminants from the watershed, which may accumulate in lake sediments over time and may be removed through the outlets. DDx, PCB, PAH, PBDE, and trace element (Hg, As, Cd, Ni, Cu, Pb) contamination was analyzed over 2001-2018 period in sediments of the 5 main tributaries and of the outlet of Lake Maggiore (Northern Italy). Sediment cores were collected in two points of the lake, covering 1995-2017 period. Concentrations were compared to Sediment Quality Guidelines (PECs), potential sources and drivers (land use, population numbers, industrial activities, hydrology) were analyzed, and temporal trends were calculated (Mann-Kendall test). PCB, PBDE, Pb, Cd, and Hg contamination derives mainly from heavy urbanization and industry. Cu and Pb show a temporal decreasing trend in the basin, likely as result of improved wastewater treatments and change in use. A recent PAH increase in the whole lake may derive from a single point source. A legacy DDx and Hg industrial pollution is still present, due to high persistence in sediments. Values of DDx, Hg, Pb, and Cu above the PECs in lake sediments and/or in the outlet show potential risk for aquatic organisms. Results highlight the key role of tributaries in driving contamination from the watershed to the lake through sediment transport.

Polycyclic musk fragrance (PMF) removal, adsorption and biodegradation in a conventional activated sludge wastewater treatment plant in Northern Italy.

The first Italian annual monitoring study was carried out in Northern Italy to analyse the fate and removal of polycyclic musk fragrances (PMFs) in a wastewater treatment plant (WWTP) with conventional activated sludge (CAS) system. Water was sampled in four different stations along wastewater treatments to better understand the behaviour of PMFs along different steps of the plant. Galaxolide (HHCB) and galaxolidone (HHCB-lactone) were found in concentrations at µg L-1 level, 1 order of magnitude greater than tonalide (AHTN), whilst phantolide (AHDI) was never detected and celestolide (ADBI) was measured only at trace levels. Considering water concentrations, HHCB and AHTN evidenced a slight reduction, 20% and 50%, respectively, during wastewater treatments, thus resulting in a modest removal efficiency, mainly due to adsorption processes during the biological treatment. This was also confirmed by the high PMF concentrations measured in activated sludges which remained stable throughout the year. On the contrary, HHCB-lactone registered an increase up to 70% during wastewater treatments caused by the biotransformation of the parental compound HHCB during the biological treatment, as shown by the different HHCB-lactone/HHCB ratio measured before and after this step. No significant differences were recorded between seasons in terms of PMF input onto WWTP, in accordance with the common use of these chemicals in civil houses. Overall, this study suggests that current technologies employed in conventional WWTP are not enough efficient in removing these organic micropollutants from wastewaters and, therefore, WWTP effluents represent possible point sources of pollution for aquatic ecosystems. Additional treatments are necessary to enhance the removal of PMFs in order to increase the quality of the WWTP effluents.

Polycyclic musk fragrances (PMFs) in wastewater and activated sludge: analytical protocol and application to a real case study.

Two different analytical methods for the determination of polycyclic musk fragrances (PMFs) in wastewater and in activated sludge were developed. PMFs in filtered water samples were determined by gas chromatography coupled with a triple-quadrupole mass spectrometer in selected reaction monitoring (SRM) mode. Activated sludge samples were extracted using an ultrasonic bath and analysed using a GC-Ion trap. The developed methods respected a linear model (R2 > 0.995). Detection limits of selected compounds (Celestolide, Galaxolide, Galaxolidone, Phantolide and Tonalide) varied from 1.7 to 80 ng L-1 for water and from 0.1 ng g-1 to 210 ng g-1 for activated sludge considering laboratory contamination for each PMF. Recovery studies were performed on spiked water samples and, for sludges, on procedural blanks, showing recoveries above 70% for all the considered compounds, while recovery of the internal standard was always above limit of acceptance (30%). Proposed methods were used to determine PMFs concentrations in wastewaters and activated sludges of a wastewater treatment plant (WWTP) located in Northern Italy. Concentrations in the range of µg L-1 of Galaxolide and of its metabolite Galaxolidone were detected even in the WWTP effluent. Biotransformation of Galaxolide into Galaxolidone occurred during biological treatment with the consequent release of this compound through WWTP effluents. In activated sludges, concentrations of all PMFs except Galaxolidone were one order of magnitude higher than wastewaters, as expected according to their physicochemical properties. Present wastewater treatment technologies were confirmed to not be efficient in removing PMFs from influent wastewaters since with only ≃ 30% of Celestolide and Tonalide were removed.

When peers count: The effects on integrated type II diabetes care of communication within general practitioner-only subgroups in interprofessional primary care teams.

BACKGROUND: Primary care teams (hereafter referred to as primary care units [PCUs]) composed of general practitioners (GPs), nurses, and specialist doctors have recently been established in the Italian context, with the main aim of improving integrated care for chronic diseases. PURPOSES: The aim of the study was to assess whether the increased professional diversity of PCUs has resulted in an improvement in the integrated care of type II diabetes and to identify a potential mechanism mediating this effect. METHODOLOGY/APPROACH: We analyzed 213 PCUs, comparing their performance in integrated type II diabetes care at two time points. Using social categorization theory and a fixed effects regression analysis, we tested a mediation model in which the frequency of communication among GPs in the PCUs, that is, within-subgroup communication, mediates the relationship between PCU professional diversity and team performance in diabetes care. FINDINGS: We show that when the professional diversity of the PCUs increases, integrated care of type II diabetes improves and better meets the standards of optimal care. Within-GP subgroup communication works as a mediating mechanism that translates the PCU professional diversity into better team performance. The mediation effect, however, is curvilinear. Beyond certain levels, within-subgroup communication can hamper PCUs' capacity to work collaboratively in integrated type II diabetes care. PRACTICE IMPLICATIONS: The article suggests that, when creating interprofessional primary care teams, managers might be able to steer teams toward a better performance by encouraging communication among peers of the same profession.

The interactions of fullerene C60 and Benzo(α)pyrene influence their bioavailability and toxicity to zebrafish embryos.

This study aimed to assess the toxicological consequences related to the interaction of fullerene nanoparticles (C60) and Benzo(α)pyrene (B(α)P) on zebrafish embryos, which were exposed to C60 and B(α)P alone and to C60 doped with B(α)P. The uptake of pollutants into their tissues and intra-cellular localization were investigated by immunofluorescence and electron microscopy. A set of biomarkers of genotoxicity and oxidative stress, as well as functional proteomics analysis were applied to assess the toxic effects due to C60 interaction with B(α)P. The carrier role of C60 for B(α)P was observed, however adsorption on C60 did not affect the accumulation and localization of B(α)P in the embryos. Instead, C60 doped with B(α)P resulted more prone to sedimentation and less bioavailable for the embryos compared to C60 alone. As for toxicity, our results suggested that C60 alone elicited oxidative stress in embryos and a down-regulation of proteins involved in energetic metabolism. The C60 + B(α)P induced cellular response mechanisms similar to B(α)P alone, but generating greater cellular damages in the exposed embryos.

Effects of Carbon Nanotube Environmental Dispersion on an Aquatic Invertebrate, Hirudo medicinalis.

The recent widespread applications of nanomaterials, because of their properties, opens new scenarios that affect their dispersal in the environment. In particular multiwall carbon nanotubes (MWCNTs), despite their qualities, seem to be harmful for animals and humans. To evaluate possible toxic effects caused by carbon nanotube environmental dispersion, with regard to aquatic compartment, we proposed as experimental model a freshwater invertebrate: Hirudo medicinalis. In the present study we analyse acute and chronic immune responses over a short (1, 3, 6 and 12 hours) and long time (from 1 to 5 weeks) exposure to MWCNTs by optical, electron and immunohistochemical approaches. In the exposed leeches angiogenesis and fibroplasia accompanied by massive cellular migration occur. Immunocytochemical characterization using specific markers shows that in these inflammatory processes the monocyte-macrophages (CD45+, CD68+) are the most involved cells. These immunocompetent cells are characterized by sequence of events starting from the expression of pro-inflammatory cytokines (in particular IL-18), and amyloidogenensis. Our combined experimental approaches, basing on high sensitive inflammatory response can highlight adverse effects of nanomaterials on aquatic organisms and could be useful to assess the MWCNTs impact on aquatic, terrestrial animal and human health.

A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions.

BACKGROUND: The mechanisms through which the relationships among public institutions, private providers and families affect care and service provision systems are puzzling. How can we understand the mechanisms in these contexts? Which elements should we explore to capture the complexity of care provision? The aim of our study is to provide a framework that can help read and reframe these puzzling care provision mechanisms in a welfare mix context. METHODS: First, we develop a theoretical framework for understanding how service provision occurs in care systems that are characterised by a variety of relationships between multiple actors, using an evidence-based approach that looks at both public and private expenditures and the number of users relative to the level of needs coverage and compared with declared values and political rhetoric. Second, we test this framework in two case studies built on data from two prominent Italian regions, Lombardy and Emilia-Romagna. We argue that service provision models depend on the interplay among six conceptual elements: policy values, governance rules, resources, nature of the providers, service standards and eligibility criteria. RESULTS: Our empirical study shows that beneath the relevant differences in values and political rhetoric between the case studies of the two Italian regions, there is a surprising isomorphism in service standards and the levels of covering the population's needs. CONCLUSION: The suggested framework appears to be effective and feasible; it fosters interdisciplinary approaches and supports policy-making discussions. This study may contribute to deepening knowledge about public care service provision and institutional arrangements, which can be used to promote more effective reforms and may advance future research. Although the framework was tested on the Italian welfare system, it can be used to assess many different systems.

Social networks of professionals in health care organizations: a review.

In this article, we provide an overview of social network research in health care, with a focus on social interactions between professionals in organizations. We begin by introducing key concepts defining the social network approach, including network density, centrality, and brokerage. We then review past and current research on the antecedents of health care professionals' social networks-including demographic attributes, professional groups, and organizational arrangements-and their consequences-including satisfaction at work, leadership, behaviors, knowledge transfer, diffusion of innovation, and performance. Finally, we examine future directions for social network research in health care, focusing on micro-macro linkages and network dynamics.

Social network analysis: foundations and frontiers on advantage.

We provide an overview of social network analysis focusing on network advantage as a lens that touches on much of the area. For reasons of good data and abundant research, we draw heavily on studies of people in organizations. Advantage is traced to network structure as a proxy for the distribution of variably sticky information in a population. The network around a person indicates the person's access and control in the distribution. Advantage is a function of information breadth, timing, and arbitrage. Advantage is manifest in higher odds of proposing good ideas, more positive evaluations and recognition, higher compensation, and faster promotions. We discuss frontiers of advantage contingent on personality, cognition, embeddedness, and dynamics.

The growth and composition of primary and community-based care services. Metrics and evidence from the Italian National Health Service.

BACKGROUND: Over the past few decades, in OECD countries there has been a general growing trend in the prevalence of out-of-hospital healthcare services, but there is a general lack of data on the use of these services. METHODS: We defined a list of 303 indicators related to primary and community healthcare services in collaboration with 13 Italian Local Health Authorities (LHAs). Then, for each LHA, we collected and analyzed these indicators for two different years (2003 and 2007). RESULTS: Out-of-hospital care absorbs 56% of all costs in our sample of LHAs. Expenditure on outpatients' visits to specialists and on diagnostic examinations accounts for 13% of the costs, while spending on primary care (including prevention and public health) accounts for 9%, and for intermediate structures (including those related to rehabilitation, elderly people, disabled people, and mental health) the figure is 11%. Different Italian LHAs have made different strategic choices with respect to primary and community-based care (PCC). CONCLUSIONS: Two distinct strategic orientations in the adoption of PCC services by LHAs has emerged from our study. The first has been an investment mainly in ambulatory and home-based primary care services in order to increase the number of low-complexity settings. A second strategy has prioritized the allocation of resources to intermediate inpatient structures for specific types of patients, namely elderly and disabled people, post-acute patients in need of rehabilitation and long-term care, and patients in hospices.

Are public health authorities able to "steer" rather than "row"? An empirical analysis in the Italian National Health Service.

The nature of the local health authorities (LHAs) in the Italian National Health Service has been deeply reformed during the 1990s by new public management (NPM) reforms that introduced decentralization, quasi-market and managerialism. These reforms implied that the main role of LHA is to govern the production of health services in their area (steer) rather than to only directly produce services (row). After more than 15 years from these reforms of Italian healthcare, we describe how much the steering versus rowing dichotomy made an impact on LHA activity, through an analysis of the management control systems they set up for themselves and the subsequent qualitative analysis of the opinions that a diverse group of managers expressed during 8 days of group discussion. Results show that managers of Italian LHAs, when only a small part of services is produced, tend to perceive their steering role as impossible to play and focus on production, leaving therefore ungoverned a significant part of the services offered to residents. NPM, therefore, was able to influence the reform of Italian healthcare but, as suggested by a postmodernist interpretation, left managers with a rhetoric change based on inconsistent assumptions instead of actionable ideas to manage the change process.