An explorative study setting a national supportive system of near-miss management for the Italian industrial sector

Initiatives, projects, and programmes for Occupational Safety and Health (OSH) management benefit from supportive systems to develop and properly last over time. National OSH systems were born to enforce the law by applying national regulations. In the last years, most countries have started to take preventative actions to improve workers’ health and safety conditions. Assistance initiatives are growing fast, and new roles and profiles are arising to keep up with changes. Nowadays, national OSH actors usually perform both supervisory and supporting activities. This is widely applied in Italy where several bodies promote and support companies in taking part in OSH initiatives. In Italy, a collaborative project for near-miss management is under development by the Italian National Institute for Insurance against Accidents at Work (INAIL, i.e., in Italian, “Istituto Nazionale Assicurazione Infortuni sul Lavoro”). The project aims at increasing awareness of the relevance of near-miss monitoring. This paper studies the environment setting for this project, so bodies that will have an active role in its implementation and daily management. A focus group with INAIL’s experts and researchers from two Italian universities has enabled to identify key actors and their role in the project’s development and to select the most viable scenarios. This work provides a methodological approach to study other national supportive OSH systems and also detects Italian best practices replicable in other countries

Sustainable Occupational Safety and Health Interventions: A Study on the Factors for an Effective Design

Effective interventions are a priority in continuously changing occupational environments, particularly in companies struggling to manage health and safety in the workplace. Practitioners may consider practical solutions for Occupational Safety and Health (OSH) improvement as a panacea for all major problems. However, they may overlook a range of other factors that affect the success of such solutions. The way in which a solution is developed, designed, implemented, and evaluated determines its impact. Participatory interventions are one way of ensuring better results. Consequently, this study proposes a way of establishing sustainable, effective, and efficient interventions by defining the required processes and actively involving responsible actors (i.e., who, when, and how). A national OSH intervention for introducing a near-miss management system, funded by the Italian National Institute for Insurance against Accidents at Work (INAIL), is used as a reference because its development process includes an accurate design stage. Based on this intervention, a multistep design process is built to answer how (how the intervention will persist by defining the context, processes, and scenarios), who (who will be the responsible actors actively participating), and when (when actors will be involved) questions. The design process established for the intervention, although within a specific context, provides clues to discriminant factors that would enable effectiveness in general interventions, and the proposed system for near- miss management generates insights that may be generalizable to other OSH interventions developed in different environments

Metallic wear in failed titanium-alloy total hip replacements. A histological and quantitative analysis

We conducted extensive histological examination of the tissues that were adjacent to the prosthesis in nine hips that had a failed total arthroplasty. The prostheses were composed of titanium alloy (Ti-6Al-4V) and ultra-high molecular weight polyethylene. The average time that the prosthesis had been in place in the tissue was 33.5 months (range, eleven to fifty-seven months). Seven arthroplasties were revised because of aseptic loosening and two, for infection. In eight hips cement had been used and in one (that had a porous-coated implant for fifty-two months) no cement had been utilized. Intense histiocytic and plasma-cell reaction was noted in the pseudocapsular tissue. There was copious metallic staining of the lining cells. Polyethylene debris and particles of cement with concomitant giant-cell reaction were present in five hips. Atomic absorption spectrophotometry revealed values for titanium of fifty-sic to 3700 micrograms per gram of dry tissue (average, 1047 micrograms per gram; normal, zero microgram per gram), for aluminum of 2.1 to 396 micrograms per gram (average, 115 micrograms per gram; normal, zero micrograms per gram), and for vanadium of 2.9 to 220 micrograms per gram (average, sixty-seven micrograms per gram; normal, 1.2 micrograms per gram). The highest values were found in the hip in which surgical revision was performed at fifty-seven months. The concentrations of the three elements in the soft tissues were similar to those in the metal of the prostheses. The factors to which failure was attributed were: vertical orientation of the acetabular component (five hips), poor cementing technique on the femoral side (three hips), infection (two hips), and separation of a sintered pad made of pure titanium (one hip). A femoral component that is made of titanium alloy can undergo severe wear of the surface and on the stem, where it is loose, with liberation of potentially toxic local concentrations of metal debris into the surrounding tissues. It may contribute to infection and loosening

Altered thymic differentiation and modulation of arthritis by invariant NKT cells expressing mutant ZAP70

Various subsets of invariant natural killer T (iNKT) cells with different cytokine productions develop in the mouse thymus, but the factors driving their differentiation remain unclear. Here we show that hypomorphic alleles of Zap70 or chemical inhibition of Zap70 catalysis leads to an increase of IFN-gamma-producing iNKT cells (NKT1 cells), suggesting that NKT1 cells may require a lower TCR signal threshold. Zap70 mutant mice develop IL-17-dependent arthritis. In a mouse experimental arthritis model, NKT17 cells are increased as the disease progresses, while NKT1 numbers negatively correlates with disease severity, with this protective effect of NKT1 linked to their IFN-gamma expression. NKT1 cells are also present in the synovial fluid of arthritis patients. Our data therefore suggest that TCR signal strength during thymic differentiation may influence not only IFN-gamma production, but also the protective function of iNKT cells in arthritis

Differential antitumor immunity mediated by NKT cell subsets in vivo

We showed previously that NKT cell–deficient TCR Jα18(−/−) mice are more susceptible to methylcholanthrene (MCA)-induced sarcomas, and that normal tumor surveillance can be restored by adoptive transfer of WT liver-derived NKT cells. Liver-derived NKT cells were used in these studies because of their relative abundance in this organ, and it was assumed that they were representative of NKT cells from other sites. We compared NKT cells from liver, thymus, and spleen for their ability to mediate rejection of the sarcoma cell line (MCA-1) in vivo, and found that this was a specialized function of liver-derived NKT cells. Furthermore, when CD4(+) and CD4(−) liver-derived NKT cells were administered separately, MCA-1 rejection was mediated primarily by the CD4(−) fraction. Very similar results were achieved using the B16F10 melanoma metastasis model, which requires NKT cell stimulation with α-galactosylceramide. The impaired ability of thymus-derived NKT cells was due, in part, to their production of IL-4, because tumor immunity was clearly enhanced after transfer of IL-4–deficient thymus-derived NKT cells. This is the first study to demonstrate the existence of functionally distinct NKT cell subsets in vivo and may shed light on the long-appreciated paradox that NKT cells function as immunosuppressive cells in some disease models, whereas they promote cell-mediated immunity in others

Modulation of NKT Cell Development by B7-CD28 Interaction: An Expanding Horizon for Costimulation

It has been demonstrated that the development of NKT cells requires CD1d. The contribution of costimulatory molecules in this process has not been studied. Here we show that in mice with targeted mutations of B7-1/2 and CD28, the TCRβ+α-Galcer/CD1d + (iVα14 NKT) subset is significantly reduced in the thymus, spleen and liver. This is mainly due to decreased cell proliferation; although increased cell death in the thymi of CD28-deficient mice was also observed. Moreover, in the B7-1/2- and CD28-deficient mice, we found a decreased percentage of the CD4−NK1.1+ subset and a correspondingly increased portion of the CD4+NK1.1− subset. In addition, the mice with a targeted mutation of either B7 or CD28 had a reduced susceptibility to Con A induced hepatitis, which is known to be mediated by NKT cells. Our results demonstrate that the development, maturation and function of NKT cell are modulated by the costimulatory pathway and thus expand the horizon of costimulation into NKT, which is widely viewed as a bridge between innate and adaptive immunity. As such, costimulation may modulate all major branches of cell-mediated immunity, including T cells, NK cells and NKT cells

EMS Systems: Foundations for the Future

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73462/1/j.1553-2712.1999.tb00094.x.pd

Unique Interplay between Sugar and Lipid in Determining the Antigenic Potency of Bacterial Antigens for NKT Cells

Structural and biophysical studies reveal the induced-fit mechanism underlying the stringent specificity of invariant natural killer T cells for unique glycolipid antigens from the pathogen Streptococcus pneumoniae