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.     

Assessment of trace metal air pollution in Paris using slurry-TXRF analysis on cemetery mosses

Mosses are useful, ubiquitous accumulation biomonitors and as such can be used for biomonitoring surveys. However, the biomonitoring of atmospheric pollution can be compromised in urban contexts if the targeted biomonitors are regularly disturbed, irregularly distributed, or are difficult to access. Here, we test the hypothesis that cemeteries are appropriate moss sampling sites for the evaluation of air pollution in urban areas. We sampled mosses growing on gravestones in 21 urban and peri-urban cemeteries in the Paris metropolitan area. We focused on Grimmia pulvinata (Hedwig) Smith, a species abundantly found in all studied cemeteries and very common in Europe. The concentration of Al, As, Br, Ca, Ce, Cl, Cr, Cu, Fe, K, Mn, Ni, V, P, Pb, Rb, S, Sr, Ti, and Zn was determined by a total reflection X-ray fluorescence technique coupled with a slurry sampling method (slurry-TXRF). This method avoids a digestion step, reduces the risk of sample contamination, and works even at low sample quantities. Elemental markers of road traffic indicated that the highest polluted cemeteries were located near the highly frequented Parisian ring road and under the influence of prevailing winds. The sites with the lowest pollution were found not only in the peri-urban cemeteries, adjoining forest or farming landscapes, but also in the large and relatively wooded cemeteries located in the center of Paris. Our results suggest that (1) slurry-TXRF might be successfully used with moss material, (2) G. pulvinata might be a good biomonitor of trace metals air pollution in urban context, and (3) cemetery moss sampling could be a useful complement for monitoring urban areas.

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Graphical abstract We tested the hypothesis that cemeteries are appropriate moss sampling sites for the evaluation of air pollution in urban areas. We sampled 110 moss cushions (Grimmia pulvinata) growing on gravestones in 21 urban and peri-urban cemeteries in the Paris metropolitan area. The concentration of 20 elements in mosses was determined by a total reflection X-ray fluorescence technique coupled with a slurry sampling method. Statistical analysis revealed that: - Urbanized Parisian areas crossed by traffic roads have the highest polluted cemeteries with a strong influence of main wind direction on the distribution of air pollutants - As expected, small cemeteries with low tree density were heavily polluted - Less obvious, large green spaces such as large cemeteries (Père Lachaise, Montmartre, Montparnasse) in the center of a dense metropolis like Paris present the same level of atmospheric trace metal pollution as cemeteries in less urbanized areas or nearing a very large forest. This suggests that even in densely urbanized areas, there is more spatial variability in pollution distribution than usually assumed and that large urban areas with low traffic and green filters such as trees are likely to intercept air pollutants

     

Saharan dust particles in snow samples of Alps and Apennines during an exceptional event of transboundary air pollution

Southern European countries are often affected in summer by transboundary air pollution from Saharan dust. However, very few studies deal with Saharan dust pollution at high altitudes in winter. In Italy, the exceptional event occurred on February 19, 2014, colored in red the entire mountain range (Alps and Apennines) and allowed to characterize the particulate matter deposited on snow from a morphological and chemical point of view. Snow samples were collected after this event in four areas in the Alps and one in the Apennines. The particulate matter of the melted snow samples was analyzed by scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDS) and by inductively coupled plasma mass spectrometry (ICP-MS). These analyses confirmed the presence of Saharan dust particle components in all areas with similar percentages, supported also by the positive correlations between Mg-Ca, Al-Ca, Al-Mg, and Al-K in all samples.     

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.     

Evaluation of microbiological air quality and of microclimate in university classrooms

The proliferation of air-diffused microorganisms inside public buildings such as schools, hospitals, and universities, is often indicated as a possible health risk. In this research, we have illustrated the results of an investigation realized to determine the health of the air in some university classrooms, both from a microbiological and a microclimatic viewpoint, during the normal didactic activity of direct lessons. The results obtained have been expressed by means of contamination indices, already used in previous works. Very little contamination was recorded in the different phases of air treatment, which underlines the efficiency of the system and of the maintenance protocols. The Global Index of Microbial Contamination (GIMC per cubic meter) showed a value greater than the mean during the heating period (290), while the highest values (95th percentile 1,138.45) were recorded in the period using air conditioning. The index of mesophilic bacterial contamination, though it did not show any significant differences in the various modes of air treatment, showed a mean value (1.34) and the 95th percentile value (4.14), which was greater in the air-conditioning phase. Finally, the mean value of the amplification index underlined a decrease in the microbial contamination in comparison to the outside, while showing situations of increased microbial amplification during the period of simple ventilation (95th percentile 4.27). The 95th percentile values found for GICM in the three sampling periods, however, permitted us to identify the value of GIMC per cubic meter equal to 1,000 as a guide to provide a means of self-monitoring the quality of the air inside the classrooms. From a microclimatic viewpoint, two periods of the year manifested discomfort situations: during the heating phase (winter) and during the simple ventilation phase (spring). The results obtained indicate, therefore, a need to intervene on the environmental parameters, not being able, in this particular case, to intervene on other aspects that influence the microclimate.     

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.     

Evaluation of a temporal trend heavy metals contamination in Posidonia oceanica (L.) Delile, (1813) along the western coastline of Sicily (Italy)

The use of biological species in the monitoring of marine environmental quality allows the evaluation of biologically available levels of contaminants in the ecosystem and the effects of contaminants on living organisms. The seagrass Posidonia oceanica is a useful bioindicator because through the lepidochronology technique it is possible to obtain a historical contamination trend of a given area. This study aims to assess the temporal trend contamination by heavy metal investigations on dead sheaths of 100 samples of P. oceanica collected in the Protected Marine Area of "Plemmirio" (Sicily) and in the Siracusa bay. Important results were obtained because data show a significant negative temporal trend for the metals analysed especially for As, Co, Cr, Hg, Pb, Se, U and V that in the past had higher concentrations, with a stronger contamination in the Plemmirio area, the site much more exposed to the pollution of the nearby petrochemical complex. This study confirms the relevance of the use of P. oceanica as a biological indicator of metal contamination in coastal ecosystems. Thus the usefulness of P. oceanica as a tracer of spatial metal contamination and as a good tool for water quality evaluation is reinforced.