Strategic decision making under climate change: a case study on Lake Maggiore water system

Abstract. Water resources planning processes involve different kinds of decisions that are generally evaluated under a stationary climate scenario assumption. In general, the possible combinations of interventions are mutually compared as single alternatives. However, the ongoing climate change requires us to reconsider this approach. Indeed, what have to be compared are not individual alternatives, but families of alternatives, characterized by the same structural decisions, i.e. by actions that have long-term effects and entail irrevocable changes in the system. The rationale is that the structural actions, once they have been implemented, cannot be easily modified, while the management decisions can be adapted to the evolving conditions. This paper considers this methodological problem in a real case study, in which a strategic decision has to be taken: a new barrage was proposed to regulate Lake Maggiore outflow, but, alternatively, either the present barrage can be maintained with its present regulation norms or with a new one. The problem was dealt with by multi-criteria decision analysis involving many stakeholders and two decision-makers. An exhaustive set of indicators was defined in the participatory process, conducted under the integrated water resource management paradigm, and many efficient (in Pareto sense) regulation policies were identified. The paper explores different formulations of a global index to evaluate and compare the effectiveness of the classes of alternatives under both stationary and changing hydrological scenarios in order to assess their adaptability to the ongoing climate change

Verbano

L’obiettivo del progetto è la soluzione del problema Verbano tramite la scelta di una nuova regolazione e di oppurtuni interventi strutturali. Tale soluzione deve tendere a minimizzare i danni causati da eventi alluvionali tanto a monte quanto a valle, i danni indotti dalla mancata fornitura idrica agli utenti irrigui ed idroelettrici di valle e quelli subiti dalla navigazione e dal turismo quando si deprimono eccessivamente i livelli lacuali, senza trascurare, nel contempo, il mantenimento di un deflusso minimo nel Ticino, a valle dello sbarramento del Panperduto. In tale ricerca si dovranno ovviamente tener conto dei vincoli posti dalla capacità di smaltimento delle portate all’incile del lago e dalla necessità di mantenere attiva la sua naturale funzione di laminazione in occasione di eventi alluvionali che interessino anche il Po

Therapy-induced antitumor vaccination in neuroblastomas by the combined targeting of IL-2 and TNF alpha

L19-IL2 and L19TNF are fusion proteins composed of L19(scFv), specific for the angiogenesis-associated ED-B containing fibronectin isoform and IL-2 or TNF. Because of the tumor targeting properties of L19, IL-2 and TNF concentrate at therapeutic doses at the tumor vascular level. To evaluate the therapeutic effects of L19-IL2 and L19mTNF in neuroblastoma (NB)-bearing mice, A/J mice bearing Neuro2A or NIE115 NB were systemically treated with L19-IL2 and L19mTNF, alone or in combination protocols. Seventy percent of Neuro2A- and 30% of NIE115-bearing mice were cured by the combined treatment with L19-IL2 and L19mTNF, and further rejected a homologous tumor challenge, indicating specific antitumor immune memory. The immunological bases of tumor cure and rejection were studied. A highly efficient priming of CD4+ T helper cells and CD8+ CTL effectors was generated, paralleled by massive infiltration in the tumor tissue of CD4+ and CD8+ T cells at day 16 after tumor cell implantation, when, after therapy, tumor volume was drastically reduced and tumor necrosis reached about 80%. The curative treatment resulted in a long-lasting antitumor immune memory, accompanied by a mixed Th1/Th2 type of response. Concluding, L19-IL2 and L19mTNF efficiently cooperate in determining a high percentage of NB cure that, in our experimental models, is strongly associated to the generation of adaptive immunity involving CD4+ and CD8+ T cells

Electrical conditioning of adipose-derived stem cells in a multi-chamber culture platform

In tissue engineering, several factors play key roles in providing adequate stimuli for cells differentiation, in particular biochemical and physical stimuli, which try to mimic the physiological microenvironments. Since electrical stimuli are important in the developing heart, we have developed an easy-to-use, cost-effective cell culture platform, able to provide controlled electrical stimulation aimed at investigating the influence of the electric field in the stem cell differentiation process. This bioreactor consists of an electrical stimulator and 12 independent, petri-like culture chambers and a 3-D computational model was used to characterize the distribution and the intensity of the electric field generated in the cell culture volume. We explored the effects of monophasic and biphasic square wave pulse stimulation on a mouse adipose-derived stem cell line (m17.ASC) comparing cell viability, proliferation, protein, and gene expression. Both monophasic (8V, 2ms, 1Hz) and biphasic (+4V, 1ms and -4V, 1ms; 1Hz) stimulation were compatible with cell survival and proliferation. Biphasic stimulation induced the expression of Connexin 43, which was found to localize also at the cell membrane, which is its recognized functional mediating intercellular electrical coupling. Electrically stimulated cells showed an induced transcriptional profile more closely related to that of neonatal cadiomyocytes, particularly for biphasic stimulation. The developed platform thus allowed to set-up precise conditions to drive adult stem cells toward a myocardial phenotype solely by physical stimuli, in the absence of exogenously added expensive bioactive molecules, and can thus represent a valuable tool for translational applications for heart tissue engineering and regeneration

Consensus Statement on Animals’ Relationship with Pediatric Oncohematological Patients, on Behalf of Infectious Diseases and Nurse Working Groups of the Italian Association of Pediatric Hematology-Oncology

: Contact with animals in pediatric oncohematologic patients is associated with many benefits, but the risk of contracting zoonoses, even if low, must be considered by clinicians. In order to assess the awareness about this topic, we surveyed the Italian pediatric oncohematology centers, which resulted in heterogeneous responses. The Infectious Diseases Working Group and the Nurse Working Group of the Italian Association of Pediatric Hematology-Oncology, together with veterinarians from the National Federation of Italian Veterinarians, drew up a consensus document to unify the indications to be given to families with the aim of guaranteeing a safe interaction between patients and animals and improving the collaboration of clinicians with veterinarians and families

The “Personal Health Budget” intervention model in early psychosis: Preliminary findings from the Parma experience

Objectives Personal Health Budget (PHB) has recently been provided to people with severe mental illness, reflecting a policy shift towards a personalized mental health care based on individual unmet needs. However, evidence on effectiveness of PHB initiatives is still limited. Aim of this research was to provide preliminary data about the beneficial effects of adding PHB to a multicomponent EIP intervention in patients with First-Episode Psychosis (FEP) along a 2-year follow-up period. Methods Participants (n = 49) were FEP patients, aged 18-50 years, entered the “Parma Early Psychosis” program and completing the Health of Nation Outcome Scale (HoNOS), the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Friedman test for repeated measure (with Wilcoxon test as post-hoc procedure) was performed to evaluate the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also carried out. Results A significant effect of time on all HoNOS, BPRS and GAF scores along the 2 years of follow-up was found. Regression analysis results specifically showed a relevant association between a PHB multiaxial intervention and the longitudinal decrease in BPRS “Negative Symptoms” subscores, as well as in HoNOS “Behavioral Problems” and “Social Problems” scores. Conclusions Our results support the general applicability of a PHB approach within an “Early Intervention in Psychosis” program for help-seeking adults with FEP

factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy

Abstract Purpose To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity. Methods and materials 537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis. Results The mean age was 74 (range 46–91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months. G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively. Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p Conclusions The results of our study, according to the large randomized trials, confirmed that hypofractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity

Ruolo dell’igienista nella sorveglianza e nel controllo dei casi sospetti di Ebola: un esempio di integrazione ospedale-territorio nella Provincia di Modena

Il Virus Ebola è un Filovirus responsabile di una grave forma di Febbre Emorragica con un tasso di letalità compreso tra il 50 e il 90%. Non esistono attualmente terapie approvate per uso umano al di fuori del trattamento di supporto: sono in fase di sviluppo differenti strategie terapeutiche fra cui vaccini, molecole interferenti con la produzione di proteine virali e anticorpi monoclonali. Da 9 mesi è in corso in Africa Occidentale nei territori di Nigeria, Sierra Leone, Guinea e Liberia la più grave ed estesa epidemia di Ebola registrata dalla scoperta del virus con più di 3000 casi fra confermati e sospetti ed oltre 1500 decessi. In ragione di ciò l’OMS ha dichiarato tale epidemia “un’emergenza di Sanità Pubblica di rilevanza internazionale” ed ha emanato specifiche raccomandazioni per i paesi direttamente colpiti e per gli Stati membri. La Regione Emilia Romagna, in accordo con le indicazioni del Ministero della Salute, ha emanato una specifica circolare sulla base della quale l’Ausl di Modena ha predisposto un piano condiviso con l’AOU Policlinico allo scopo di individuare e gestire prontamente i casi sospetti. L’agente infettivo viene trasmesso per contatto diretto di mucose o cute non integra coi fluidi corporei e secrezioni di persone e animali infetti. Dopo un periodo di incubazione variabile tra 2 e 21 giorni, i primi sintomi di malattia sono aspecifici (febbre, malessere generale, cefalea, mialgie) mentre col progredire dell’infezione si può assistere ad un’evoluzione verso l’insufficienza multi-organo o forme francamente emorragiche. Sono state formalizzate istruzioni operative per la gestione protetta del caso sospetto, dall’accettazione, alla diagnosi, fino al trasferimento presso i centri di riferimento nazionali (Spallanzani-Roma, Sacco-Milano), resi fruibili dispositivi di protezione individuali per gli operatori e informato il personale sanitario dei percorsi strutturati mediante adeguati corsi di formazione. A livello locale, le Direzioni Sanitarie dovranno promuovere l’integrazione delle attività di comunicazione tra le diverse strutture coinvolte (ospedali, distretti, Dipartimenti di Sanità Pubblica, Dipartimenti delle Cure Primarie, Servizi di Continuità Assistenziale) con i medici di medicina generale e i pediatri di libera scelta, per garantire un’informazione corretta sulla malattia, sui rischi e sulle misure di prevenzione e per contribuire ad evitare immotivati allarmismi, facendo riferimento a quanto pubblicato e costantemente aggiornato sul sito del Ministero della Salute

Hybrid fibroin/polyurethane small-diameter vascular grafts: from fabrication to in vivo preliminary assessment

To address the need of alternatives to autologous vessels for small-calibre vascular applications (e.g. cardiac surgery), a bio-hybrid semi-degradable material composed of silk fibroin (SF) and polyurethane (Silkothane (R)) was herein used to fabricate very small-calibre grafts (o(in) = 1.5 mm) via electrospinning. Bio-hybrid grafts were in vitro characterized in terms of morphology and mechanical behaviour, and compared to similar grafts of pure SF. Similarly, two native vessels from a rodent model (abdominal aorta and vena cava) were harvested and characterized. Preliminary implants were performed on Lewis rats to confirm the suitability of Silkothane (R) grafts for small-calibre applications, specifically as aortic insertion and femoral shunt. The manufacturing process generated pliable grafts consisting of a randomized fibrous mesh and exhibiting similar geometrical features to rat aortas. Both Silkothane (R) and pure SF grafts showed radial compliances in the range from 1.37 +/- 0.86 to 1.88 +/- 1.01% 10(-2) mmHg(-1), lower than that of native vessels. The Silkothane (R) small-calibre devices were also implanted in rats demonstrating to be adequate for vascular applications; all the treated rats survived the surgery for three months after implantation, and 16 rats out of 17 (94%) still showed blood flow inside the graft at sacrifice. The obtained results lay the basis for a deeper investigation of the interaction between the Silkothane (R) graft and the implant site, which may deal with further analysis on the potentialities in terms of degradability and tissue formation, on longer time-points