Ultrasonography in pregnancy and fetal abnormalities: Screening or diagnostic test? IPIMC 1986–1990 register data

The aim of the present study was to assess the sensitivity of ultrasound diagnosis used as a screening test in detecting major congenital anomalies in the prenatal period in a large nation-based multicentre setting. Data from the IPIMC register were collected in the period 1986–1990. One hundred and thirty-five hospitals, located in 17 out of the 20 regions in Italy, participated in the register. Study cases were 3479 infants with major congenital anomalies diagnosed at birth or in the first week of life. Subjects with chromosomal anomalies or multiple defects were excluded. The sensitivity of ultrasound prenatal diagnosis was 49.5 per cent for central nervous system anomalies, 3.8 per cent for congenital heart diseases, 17.1 per cent for gastrointestinal tract defects, 46.6 per cent for abdominal wall defects, 74.8 per cent for urinary tract anomalies, and 22.9 per cent for skeletal abnormalities. The detection rate for diaphragmatic hernia was 24.2 per cent. Overall, only 18 per cent of the defects diagnosed in utero were detected before 24 weeks' gestation. The sensitivity of prenatal diagnosis was 30.1 and 19.0 per cent in the northern, central, and southern regions, respectively. In light of its low sensitivity, ultrasonography as a screening test in the general population should be abandoned, although some improvement in its performance should be expected following adequate training of the ultrasound staff and the use of good technical equipment.     

Experimental approaches for size-based metal speciation in rivers

A review of the different methodologies employed to fractionate and characterize riverine suspended particulate matter is presented. The importance of size-based metal speciation is underlined and the possibility of studying it by the Sedimentation Field Flow Fractionation (SdFFF) technique is illustrated. The studies on the metal load in river Suspended Particulate Matter (SPM) performed over the last ten years are critically reviewed focusing on the different methods employed to collect, concentrate and size-fractionate samples. The fact that there is no homogeneity in methods and data collection in this field is underlined. Among the different fractionation techniques, Field Flow Fractionation (FFF) methodologies have proved to be a good approach to study the role of SPM in metal load and transport. The possibility of studying size-based metal speciation using the SdFFF technique is presented and the importance of metal speciation in rivers is underlined.     

Assessing the value of pastoral farming in the Alps using choice experiments: evidence for public policies and management

Alpine livestock farms consist of pastures, buildings, people and animals, and are a key element for the economy in the Alps. Pastures and huts are often owned by the local municipalities, who lease them to private tenants. However, this activity is often no longer profitable, and thus pastures and huts remain unused and abandoned. This research provides an economic estimate of pastoral farming using the choice experiment (CE) method, also assessing the willingness to pay (WTP) for pastoral farming functions. The study examines different scenarios of upland farm management in order to provide recommendations for public owners on how to better manage these assets. The case study is located in an alpine area in northern Italy. Our results show a higher WTP for the attributes related to the traditional Alpine agricultural economy, with an emphasis on grazing. Several policy implications regarding agricultural renewal and support for mountain livelihoods are highlighted in the conclusions.     

A human factors and reliability approach to clinical risk management: Evidence from Italian cases

Similarly to the industrial sector in the late 1980s, nowadays leading organizations in the healthcare sector acknowledge the fact that human errors, adverse events and system failures must be managed and controlled. Whilst Human Reliability Analysis (HRA) has been well-accepted and integrated into safety management processes in other industries, the application of such error techniques to the problem of managing the associated risks in healthcare is rare. The main purpose of this research is to analyse clinical risk management (CRM) and patient safety improvement in Italian healthcare organizations, through human factors and human reliability theories. In particular, the specific objectives are to explore the Italian state-of-the-art in CRM, with regard to organizational and managerial issues; to identify and verify the factors influencing the growth and sharing of the safety culture and to understand and describe the possibility of transferring human reliability methodologies and theories to the domain of healthcare.Six case studies belonging to the Italian scenario have been performed, in order to describe the Italian healthcare system and to identify the key influencing factors of CRM policies.Results obtained from within and cross-case analysis give an empirical contribution to the recent introduction of CRM in the Italian context and a theoretical contribution referring to the framework used to analyse CRM in healthcare organizations, and to the indications which emerged on the key factors influencing CRM.     

Ammonia as confounding factor in toxicity tests with the sea urchin Paracentrotus lividus (Lmk)

The aim of this study was to investigate the toxicity of total ammonia towards sea urchin bioassays, in order to elucidate the role of ammonia as confounding factor in sediment quality assessment studies. New toxicity data, expressed as EC50, NOEC and LOEC are reported for Paracentrotus lividus based on experiments at differing pH values. Results confirmed that sperm cell toxicity test is not very sensitive to ammonia, while total ammonia embryotoxicity is strictly pH dependent. Accurate observations of embryotoxic effects at increasing total ammonia concentrations evidenced progressive shifts from malformed plutei to gastrula and blastula blockages. Toxicity data obtained for P. lividus are comparable with previous results with other echinoid species.