A model-based ultrametric composite indicator for studying waste management in Italian municipalities

A Composite Indicator (CI) is a useful tool to synthesize information on a multidimensional phenomenon and make policy decisions. Multidimensional phenomena are often modeled by hierarchical latent structures that reconstruct relationships between variables. In this paper, we propose an exploratory, simultaneous model for building a hierarchical CI system to synthesize a multidimensional phenomenon and analyze its several facets. The proposal, called the Ultrametric Composite Indicator (UCI) model, reconstructs the hierarchical relationships among manifest variables detected by the correlation matrix via an extended ultrametric correlation matrix. The latter has the feature of being one-to-one associated with a hierarchy of latent concepts. Furthermore, the proposal introduces a test to unravel relevant dimensions in the hierarchy and retain statistically significant higher-level CIs. A simulation study is illustrated to compare the proposal with other existing methodologies. Finally, the UCI model is applied to study Italian municipalities’ behavior toward waste management and to provide a tool to guide their councils in policy decisions.

Job Satisfaction: Knowledge, Attitudes, and Practices Analysis in a Well-Educated Population

Job satisfaction has a huge impact on overall life quality involving social relationships, family connection and perceived health status, affecting job performances, work absenteeism and job turnover. Over the past decades, the attention towards it has grown constantly. The aim of this study is to analyze simultaneously knowledge, attitudes, and practices toward job satisfaction in a general population in a large metropolitan area. The data acquired from 1043 questionnaires-administered to subjects with an average age of 35.24 years-revealed that only 30% is satisfied by his job. Moreover, among all the tested sample, 12% receive, or often receive intimidation by their superior, and 23% wake up unhappy to go to work. Marital status and having children seem to be an important factor that negatively influences job satisfaction through worst behaviours. The multiple linear regression analysis shows how knowledge is negatively correlated to practices; although this correlation is not present in a simple linear regression showing a mediation role of attitudes in forming practices. On the contrary, attitudes, correlated both to knowledge and practices, greatly affect perceived satisfaction, leading us to target our proposed intervention toward mindfulness and to improve welfare regulation towards couples with children.

Occurrence, Distribution, and Risk Assessment of Organophosphorus Pesticides in the Aquatic Environment of the Sele River Estuary, Southern Italy

The intensive use of organophosphorus pesticides (OPPs) causes concern among authorities in different countries, as many of them, remaining unchanged for a long time, pose a threat to environmental sustainability. This study assessed the spatio-temporal trends of nine OPPs in the water dissolved phase (WDP), suspended particulate matter (SPM), and sediment samples from the Sele River estuary, Southern Italy. Samples were collected in 10 sampling sites during four seasons. The highest levels were found at the mouth (mean value 28.25 ng L⁻¹ as WDP + SPM) and then decreased moving southwards to the Mediterranean Sea. Moreover, highest concentrations were detected in the warm season (July) with a mean value of 27.52 ng L⁻¹. The load contribution to the Mediterranean Sea was evaluated in about 61.5 kg year⁻¹, showing that the river was an important source of OPPs through discharge into the sea. The risk assessment revealed that no high-risk indices for the general-case scenario were observed, but for the worst-case scenario, potential risks were associated with chlorpyrifos, pyrimifos-methyl, and parathion, suggesting that OPP contamination should not be neglected. This study makes up the first record of OPPs in the surface waters of the Sele River and provides helpful data as a starting point for future studies.

Occurrence and spatial-temporal distribution of atrazine and its metabolites in the aquatic environment of the Volturno River estuary, southern Italy

The present study assesses the spatial distribution and temporal trends of the water dissolved phase (WDP), suspended particulate matter (SPM) and sediment partitioning of atrazine (ATR) and its metabolites in the Volturno River estuary. The load contribution of ATR and its metabolites in this river to the Central Mediterranean Sea was estimated. Samples were collected in 10 sampling sites during the four seasons. The total concentrations of ATR and DPs detected ranged from 18.1 to 105.5 ng L^-1 in WDP, from 4.5 to 63.2 ng L^-1 in SPM, and from 4.6 to 18.6 ng g^-1 in sediment samples, indicating high levels of these pollutants. Structural equation model and the ratio study indicated that the relationship between sediment and WDP pollutants occurred through the SPM. The pollutants load at the Volturno River in its mouth was evaluated in about 30.4 kg year^-1, showing that this river is an important source of these analytes through discharge into Central Mediterranean Sea. Principal component analysis indicated that ATR and its metabolites pollution moves from Volturno River mouth southward and increased in the rainy season. The desethylatrazine-to-atrazine ratio was higher than 0.5 for all samples analyzed, indicating an historical discharge and a long residence time of ATR in sediment about two decades after its ban, and classifying ATR as a nonpoint source contaminant. This study makes up the first record of ATR and its metabolites in superficial water of Southern Italy and provides helpful data as starting point for future studies.

Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg increases efficacy and duration of benefits of low-intensity extracorporeal shock wave therapy for erectile dysfunction: A prospective, randomized, single-blinded study with 1-year follow-up

Purpose

To investigate a therapeutic protocol for erectile dysfunction (ED) based on the combination of low-intensity extracorporeal shock wave therapy (Li-ESWT), tadalafil, and L-arginine.

Materials and Methods

Recruited patients completed the International Index of Erectile Function erectile function domain (IIEF-EF) and the Erection Hardness Score (EHS) questionnaires at baseline and were randomly assigned in two groups: A (treatment group) and B (control group). Men in both groups received six weekly applications of Li-ESWT. Group A was prescribed adjuvant oral therapy with tadalafil 5 mg and L-arginine 2,500 mg. Follow-up visits were scheduled 1, 6, and 12 months after the last Li-ESWT application. At each follow-up visit, the IIEF-EF and EHS questionnaires were administered again. The main outcome measures were the changes from baseline to every follow-up visit in IIEF-EF and EHS scores.

Results

The mean IIEF-EF score in group A was 16.0±4.0, 24.8±3.4, 23.3±4.6, and 21.6±5.5 at baseline, 1, 6, and 12 months of follow-up, respectively, whereas in group B the mean IIEF-EF score was 16.5±4.1, 22.7±4.2, 21.5±4.5, and 19.5±4.9, respectively. We reported an increase in the mean EHS score in group A from 2.07±0.72 at baseline to 3.39±0.59, 3.17±0.67, and 2.98±0.72 at 1, 6, and 12 months, respectively, and in group B from 2.12±0.80 at baseline to 3.07±0.78 and 2.95±0.76 at 1 and 6 months, respectively.

Conclusions

Adjuvant daily therapy with L-arginine 2,500 mg and tadalafil 5 mg was safe and effective in increasing the efficacy and the duration of benefits of Li-ESWT.

The use of mobile phone while driving: Behavior and determinant analysis in one of the largest metropolitan area of Italy

The use of mobile phones while driving is one of the main causes of road accidents and it is a phenomenon in continuous growth. The key aim of this study is to analyse simultaneously knowledge, attitudes, and behavior toward the use of mobile phones while driving in one of the largest and populous metropolitan areas of Italy, Naples. The data acquired from 774 questionnaires - administered to subjects evenly divided by gender and with an average age of 39 years - revealed that 69 % have used their mobile phone while driving at least once in their lifetime. Among those who used the phone, 63.6 % use it to make phone calls while 75.2 % only to answer them; 49.1 % read messages and only 33.3 % write them. It is also notable that 34.1 % do not stop to answer a call and only 10 % do not value the use of headsets while driving as fundamental. The results indicate that cell phone usage while driving is common in the study population, despite many having university-level education and satisfactory risks awareness. The multiple linear regression analysis shows how knowledge is not correlated to the behavior held. On the contrary, attitudes are strongly correlated to knowledge and behavior, meaning that good attitudes bring forth positive behavior. According to the collected data and statistical analysis, it is possible to identify factors that can greatly affect the use of mobile phone while driving and establish targeted prevention programs.

Management of oxygen saturation monitoring in preterm newborns in the NICU: the Italian picture

Background

Although many studies emphasize the importance of using oxygen saturation (SpO₂) targets in the NICUs, there is a wide variability in used saturation ranges among centers. Primary aim was to draw a representative picture on how the management of oxygen monitoring is performed in the Italian NICUs. Second aim was to identify healthcare-professionals related factors associated with oxygen targeting in the preterm population.

Methods

Cross-sectional study with data collection via an electronic survey form. A questionnaire containing pre-piloted and open questions on monitoring and management of the SpO₂ was administered to neonatologists across the network of the Italian Society of Neonatology. The questions focused on: the infrastructure, specific training, healthcare professionals and patients-related factors. The results of the survey were anonymously collected, summarized and analyzed.

Results

Out of 378 questionnaires, 93 were correctly filled. Thirty-six different SpO₂ ranges were observed. Centers using written standard operating procedures on oxygen management and SpO₂ monitoring maintained a correct average range of SpO₂ 90–95%, avoided hyperoxia and reconsidered saturation targets in relation to comorbidities. 39.8% of responders disabled alarms during neonatal care. One center used biomarkers for complete monitoring of neonatal oxygenation status.

Conclusions

There is considerable variation in SpO₂ targets for preterm infants in the Italian NICUs. Standard operating procedures and specific training for health care personnel are the main factors playing a role for the correct maintenance of the recommended oxygen targets in preterms.

The Daily Therapy With L-Arginine 2,500 mg and Tadalafil 5 mg in Combination and in Monotherapy for the Treatment of Erectile Dysfunction: A Prospective, Randomized Multicentre Study

INTRODUCTION

A synergistic effect of the combination therapy tadalafil plus L-Arginine is conceivable in patients affected by erectile dysfunction (ED).

AIM

To evaluate the effectiveness and tolerability of tadalafil 5 mg and L-Arginine 2.5 grams in monotherapy and combination therapy.

METHODS

Recruited patients completed the International Index of Erectile Function - Erectile Function domain (IIEF-EF) and Sexual Encounter Profile diaries completed at baseline and after treatment. The survey was randomized into 3 groups with an equal allocation ratio. Group A received daily L-Arginine 2,500 mg, group B received daily tadalafil 5 mg, and group C received both daily L-Arginine 2,500 mg plus daily tadalafil 5 mg. The duration of therapy in all 3 groups was 12 weeks. Safety was assessed by evaluating all reported treatment-emergent adverse events.

MAIN OUTCOME MEASURE

The main outcome measure was the change in IIEF-EF score and in per-patient percentage of "yes" responses to Sexual Encounter Profile Question 3 from baseline to after treatment.

RESULTS

300 eligible patients were enrolled, and 100 subjects for each group were allocated. Based on the IIEF-EF score, the participants were divided into 3 categories: severe, moderate, and mild ED. IIEF-EF score increased in group A from 15 ± 7 to 18.1 ± 9.2, in group B from 14.8 ± 6.9 to 20.8 ± 7.3, and in group C from 14.9 ± 7.1 to 22 ± 7.5. In mild ED group, the mean IIEF-EF score increased from 22.1 ± 2.2 to 27.5 ± 2.3 in group A; from 22.1 ± 2.2 to 27.8 ± 2 in group B, and from 22.2 ± 2.2 to 29.3 ± 0.9 in group C. We report a total of 11, 53, and 67 cases of adverse events in group A, B, and C respectively.

CONCLUSIONS

Combination therapy was superior to monotherapies. Gallo L, Pecoraro S, Sarnacchiaro P, et al. The Daily Therapy With L-Arginine 2,500 mg and Tadalafil 5 mg in Combination and in Monotherapy for the Treatment of Erectile Dysfunction: A Prospective, Randomized Multicentre Study. Sex Med 2020;8:178-185.

Ecological risk and estimates of organophosphate pesticides loads into the Central Mediterranean Sea from Volturno River, the river of the "Land of Fires" area, southern Italy

The organophosphate pesticides pollution in the Volturno River and its environmental impact on the Tyrrhenian Sea (Central Mediterranean Sea) were estimated. Eight selected organophosphate pesticides (diazinon, dimethoate, malathion, chlorpyrifos, pirimiphos-methyl, fenitrothion, methidathion and tolclofos-methyl) were determined in the water dissolved phase, suspended particulate matter and sediment samples collected from 10 sites in different seasons. Total organophosphate pesticides concentrations ranged from 0.12 to 65.09 ng L^-1 in water (as the sum of the water dissolved phase and suspended particulate matter) and from 1.19 to 23.17 ng g^-1 in sediment samples. It has been calculated that the discharge of pollutants from the Volturno river into the Tyrrhenian Sea was about 71.815, 31 g year^-1; for this reason the river is to be considered one of the main mouths of organophosphate pesticides in the Tyrrhenian Sea. In relation to environmental risk assessment, the concentrations of most OPPs in water and sediments from the Volturno River and its estuary were lower than guideline values, but the mean concentration of chlorpyrifos (5.41 ng L^-1) in the Volturno River and Estuary has been shown that the ecological integrity of the river watercourse is possibly at risk.

Ten-year experience with multimodal treatment for acute phase Peyronie's disease: A real life clinical report

OBJECTIVES

To present our experience with multimodal therapy for Peyronie's disease.

METHODS

Retrospective data were collected since 2008 to 2017. The following features were evaluated at baseline and after treatment: age, duration of disease, erectile function, erected penile curvature, and stretched penile length. All patients were offered the same protocol including: 12 intralesional verapamil injections, oral therapy (OT) ?L-arginine 2g once and pentoxifylline 400mg 3 times a day for 6 months?, and penile traction therapy. The adherence to each of the 3 components of multimodal treatment was evaluated.

RESULTS

One hundred and seventy-seven individuals were considered. Depending on the grade of adherence our survey was divided into 3 groups. Group 1: patients who only completed OT; group 2: men who accomplished OT and intralesional verapamil injections; group 3: patients who completed the entire protocol. Seventy-six, 45 and 56 men were assigned to group 1, 2 and 3 respectively. The mean age at the diagnosis was 59±8.4, 59.1±5.9 and 54.2±4.8 years, while the mean duration of the disease was 6.3±3.4, 4.8±2.9 and 3.9±3.1 months in group 1, 2 and 3. The erected penile curvature before and after treatment was 24.2±9 and 23.7±8.9° in group 1 (P<.36); 25.4±16.8 and 24.1±13.6° in group 2 (P<.34), and 34.3±17.9 and 26.1±17.2° in group 3 (P<.001).

CONCLUSIONS

OT alone was successful to block the progression of the disease. The add of intralesional verapamil injections to OT brought only mild improvements. The complete protocol significantly reduced erected penile curvature and improved erectile function.

Genetically modified food versus knowledge and fear: A Noumenic approach for consumer behaviour

The theme of genetically modified organisms is very important for modern consumers, especially when they approach novel foods. In this paper, we have attempted to assess the impact of genetically modified foods on the consumers' preferences, considering a new vision of ours: however, the conclusions also form a topic for further discussion. We conducted an investigation on a sample size survey. The analysis was carried out in a representative sample of more than 900 Italian families, selected based on a functional relationship to the objectives of the work. The aims of the present study were: firstly, investigating consumers' preferences regarding genetically modified food consumption and developing a quantitative model to formalize the origins of behaviours regarding consumers' preferences toward genetically modified food consumption; secondly, detecting the drivers of their purchase, underlining that only by reasoning it is possible to ensure that specific variables do not condition purchasing behaviour.

C reactive protein in healthy term newborns during the first 48 hours of life

BACKGROUND

Early-onset neonatal sepsis (EOS) is a serious and potentially life-threatening disease in newborns. C reactive protein (CRP) is the most used laboratory biomarker for the detection of EOS. Little is known about normal reference values of CRP during the perinatal period as several factors are able to influence it.

OBJECTIVES

To identify an appropriate range of CRP values in healthy term newborns during the first 48 hours of life.

DESIGN

CRP determination was performed in 859 term newborns at 12, 24 and 48 hours of life. Mode of delivery, maternal vaginal culture results, intrapartum antimicrobial prophylaxis (IAP) and other perinatal variables were recorded.

RESULTS

CRP mean values were significantly higher at 48 hours (4.10 mg/L) than at both 24 (2.30 mg/L) and 12 hours of life (0.80 mg/L). CRP levels were affected by a number of perinatal proinflammatory variables. In particular, CRP mean values were significantly higher in babies born by vaginal delivery (3.80 mg/L) and emergency caesarean section (3.60 mg/L) than in babies born by elective caesarean section (2.10 mg/L). Completed course of IAP led to lower CRP mean values (2.90 mg/L) than IAP not completed (3.80 mg/L) or not performed (4.70 mg/L).

CONCLUSIONS

Postnatal age and mode of delivery significantly influence CRP values. Reliable reference values are crucial in order to obtain an adequate diagnostic accuracy.

Distribution, sources and ecological risk assessment of polycyclic aromatic hydrocarbons in water and sediments from Tiber River and estuary, Italy

The concentration, source and ecological risk of polycyclic aromatic hydrocarbons (PAHs) in the Tiber River and its environmental impact on the Tyrrhenian Sea (Central Mediterranean Sea) were estimated. The 16 priority PAHs were determined in the water dissolved phase (DP), suspended particulate matter (SPM) and sediments collected from 21 sites in four different seasons. Total concentrations of PAHs ranged from 10.3 to 951.6ngL(-1) and from 36.2 to 545.6ngg(-1) in water (sum of DP and SPM) and in sediment samples, respectively. The compositions of PAHs showed that 2- to 4-ring PAHs were abundant in DP, 4- to 6-ring PAHs were predominant in SPM samples, and 4- to 5-ring PAHs were abundant in sediments. The diagnostic ratio analysis indicated that the PAHs mainly had a pyrolytic source. The toxic equivalent concentration of carcinogenic PAHs was 45.3ngTEQg(-1), suggesting low carcinogenic risk for Tiber River. Total PAHs loads into the sea were calculated in about 3161.7kgyear(-1) showing that this river is one of the main contribution sources of these contaminants to the Tyrrhenian Sea.

Estimates of Tiber River organophosphate pesticide loads to the Tyrrhenian Sea and ecological risk

The organophosphate pesticides pollution in the Tiber River and its environmental impact on the Tyrrhenian Sea (Central Mediterranean Sea) were estimated. Eight selected organophosphate pesticides (diazinon, dimethoate, malathion, chlorpyrifos, pirimiphos-methyl, fenitrothion, methidathion, tolclofos-methyl) were determined in the water dissolved phase, suspended particulate matter and sediment samples collected from 21 sites in different seasons. Total organophosphate pesticides concentrations ranged from 0.40 to 224.48ngL(-1) in water (as the sum of the water dissolved phase and suspended particulate matter) and from 1.42 to 68.46ngg(-1) in sediment samples. Contaminant discharges of organophosphate pesticides into the sea were calculated in about 545.36kgyear(-1) showing that this river should be consider as one of the main contribution sources of organophosphate pesticides to the Tyrrhenian Sea. In relation to the eco-toxicological assessment, the concentrations of most OPPs in the water and sediments from the Tiber River and its estuary were lower than guideline values.

Genetically Modified Foods and Consumer Perspective

Genetically modified food is able to oppose the world's hunger and preserve the environment, even if the patents in this matter are symptomatic of several doubts. And also, transgenic consumption causes problems and skepticism among consumers in several European countries, but above all in Italy, where there is a strong opposition over recent years. So, the present study conducted a research to study the consumption of genetically modified food products by Italian young generation. This research presented the following purposes: firstly, to analyze genetically modified products' consumption among a particular category of consumers; secondly, to implement a quantitative model to understand behaviour about this particular kind of consumption and identify the factors that determine their purchase. The proposed model shows that transgenic consumption is especially linked to knowledge and impact on environment and mankind's health.

The association in a two-way contingency table through log odds ratio analysis: the case of Sarno river pollution

In this paper we are proposing a general framework for the analysis of the complete set of log Odds Ratios (ORs) generated by a two-way contingency table. Starting from the RC (M) association model and hypothesizing a Poisson distribution for the counts of the two-way contingency table we are obtaining the weighted Log Ratio Analysis that we are extending to the study of log ORs. Particularly we are obtaining an indirect representation of the log ORs and some synthesis measures. Then for studying the matrix of log ORs we are performing a generalized Singular Value Decomposition that allows us to obtain a direct representation of log ORs. We also expect to get summary measures of association too. We have considered the matrix of complete set of ORs, because, it is linked to the two-way contingency table in terms of variance and it allows us to represent all the ORs on a factorial plan. Finally, a two-way contingency table, which crosses pollution of the Sarno river and sampling points, is to be analyzed to illustrate the proposed framework.

Hair mercury levels in an urban population from southern Italy: fish consumption as a determinant of exposure

Mercury levels in hair of a general population, 237 adults aged between 35-45, in Naples, Italy, were assessed. The subjects were asked to fill in a questionnaire about age, gender, body weight, height, body mass index (BMI), fish consumption, number, surface and area of dental amalgam fillings. Total mercury (THg) concentrations in human hair ranged from 0.221 to 3.402 microg/g and the mean value for the subjects under study was 0.638 microg/g. Study participants were divided into three groups in accordance with fish consumption and dental amalgam: ANF (amalgam and no fish); NAF (no amalgam but with fish) and AAF (amalgam and fish). Significant differences in THg were found in the three groups (p<0.05). A multiple linear regression analysis showed a weak but significant correlation of THg content in hair with respect to gender and age, but almost no association was found between THg and dental fillings. Conversely, a strong correlation was obtained between THg and fish consumption regardless of the group evaluated. Finally, mercury levels in hair exceeded the levels corresponding to the EPA reference dose (RfD) of 0.1 microg Hg/kg body weight per day (1 microg Hg/g hair) in 6% of the population (4% men and 2% women). However, the THg limits in our subjects were not exceeded according to the WHO guidelines, which use a benchmark dose of 0.23 microg Hg/kg bw/day (14 microg Hg/g maternal hair).