Regional risk assessment for contaminated sites part 3: spatial decision support system.

Large scale (e.g. regional or national) assessments of contaminated sites may be very costly in terms of investigation and methodological (i.e. risk assessment procedures) requirements and may produce a quantity of information that usually discourages examination by decision-makers. Moreover, most of the existing tools effectively support local environmental risk assessment and management, but lack the capabilities of larger scale analysis, not mentioning the absence of the relevant component of socio-economic prioritization. To respond to the concerns and the management needs of experts and decision makers, the Spatial decision support sYstem for Regional rIsk Assessment of Degraded land (SYRIADE DSS) was developed and is presented according to its three modules: Regional Risk Assessment, Socio-economic Assessment and Integrated Assessment, respectively. The system allows to rank potentially contaminated sites for priority of investigation, when no information on characterization and risk by site specific methodologies is available. This GIS-based system embeds an innovative spatial and relative risk assessment procedure, and proposes the integrated analysis of different data (environmental and socio-economic) for the concerned sites, eliciting when necessary experts' knowledge and stakeholders' values (through Multi Criteria Decision Analysis, MCDA, methodologies). The application to a Polish case-study shows the performance and the flexibility of the system in investigating and mapping (potentially) contaminated sites at the regional scale.

Regional risk assessment for contaminated sites part 2: ranking of potentially contaminated sites.

Environmental risks are traditionally assessed and presented in non spatial ways although the heterogeneity of the contaminants spatial distributions, the spatial positions and relations between receptors and stressors, as well as the spatial distribution of the variables involved in the risk assessment, strongly influence exposure estimations and hence risks. Taking into account spatial variability is increasingly being recognized as a further and essential step in sound exposure and risk assessment. To address this issue an innovative methodology which integrates spatial analysis and a relative risk approach was developed. The purpose of this methodology is to prioritize sites at regional scale where a preliminary site investigation may be required. The methodology aimed at supporting the inventory of contaminated sites was implemented within the spatial decision support sYstem for Regional rIsk Assessment of DEgraded land, SYRIADE, and was applied to the case-study of the Upper Silesia region (Poland). The developed methodology and tool are both flexible and easy to adapt to different regional contexts, allowing the user to introduce the regional relevant parameters identified on the basis of user expertise and regional data availability. Moreover, the used GIS functionalities, integrated with mathematical approaches, allow to take into consideration, all at once, the multiplicity of sources and impacted receptors within the region of concern, to assess the risks posed by all contaminated sites in the region and, finally, to provide a risk-based ranking of the potentially contaminated sites.

A predictive model to allocate frequent service users of community-based mental health services to different packages of care.

AIM: To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifying the costs of these packages. METHODS: Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. RESULTS: Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. CONCLUSION: It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Using multiple indices to evaluate scenarios for the remediation of contaminated land: the Porto Marghera (Venice, Italy) contaminated site.

BACKGROUND, AIM, AND SCOPE: The management of contaminated sites requires the investigation of different involved aspects (from socioeconomic to risk and technological issues) and the presentation of useful and condensed information to decision makers. For this purpose, indices are more and more recognized as effective and valuable tools. This paper presents specific indices created within the DEcision Support sYstem for REhabilitation of contaminated sites (DESYRE). MATERIALS AND METHODS: DESYRE is a software which aids decision making for the rehabilitation of a large contaminated site (i.e., megasite) by the creation and comparison of different rehabilitation alternatives. The software is composed of six modules, each dealing with a specific aspect of the remediation process, ending with the decision module. In this module, scenarios (i.e., suitable solutions for the rehabilitation of the contaminated site including selected land use, socioeconomic benefits, remediation costs, time span, environmental impacts, technology set/s, and residual risk) are created and evaluated by means of suitable indices. Nine indices cover the socioeconomic, risk, technological, cost, time, and environmental impact aspects. Mathematical algorithms are used to calculate these indices by taking into account data collected during the analytical steps of the DESYRE system and elaborated through the support of the spatial analysis, which is embedded in the system. RESULTS: The case study of Porto Marghera, Venice, Italy is presented in order to document the effectiveness of developed indices in evaluating management solutions and presenting options to decision makers. For the purpose of this study, three different scenarios for the remediation of a part of the site of Porto Marghera (approximately 530 ha) are developed and compared. The three scenarios consider the industrial land use and deal with the contamination in soil caused by inorganic and organic compounds. The scenarios mainly differ for the number of the included remediation technologies and for the spatial distribution of the technologies on the considered area. DISCUSSION: Indices results allow the user to more easily evaluate the advantages and limits of each scenario in order to select the most appropriate one. For instance, the risk indices allow the user to identify scenarios with good performance in reducing the extension of risk areas and the risk magnitude. Equally, the technological indices support the achievement of efficient remedial solutions characterized by a limited number of technologies, applied to extended areas and with high performance. The environmental impact index allows users to estimate the wider effects on the environment of the selected solutions, while the socioeconomic index is the result of social and economic investigations of the regional and local conditions, which ends with the identification of the best land use (e.g., the industrial one for the Porto Marghera area). CONCLUSIONS: The proposed nine DESYRE indices provide more complete information to investigate suitable management solutions. DESYRE indices facilitate the definition of a consensus among stakeholders and the achievement of a widely shared solution for contaminated site management, even at larger sites, such as Porto Marghera. RECOMMENDATIONS AND PERSPECTIVES: Further improvements to the system may be adopted, e.g., the possibility to aggregate results of the different assessments into one synthetic index per scenario or the inclusion of a Group Decision Making procedure.

[Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost)]. / Proposta per un nuovo sistema di finanziamento dei dipartimenti di salute mentale. Risultati di uno studio valutativo multicentrico nazionale (I-psycost study).

AIMS: To obtain a new, well-balanced mental health funding system, through the creation of (i) a list of psychiatric interventions provided by Italian Community-based Psychiatric Services (CPS), and associated costs; (ii) a new prospective funding system for patients with a high use of resources, based on packages of care. METHODS: Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographical and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were registered and categorised into 24 service contact types. Using elasticity equation and contact characteristics, we estimate the costs of care. Cluster analysis techniques identified packages of care. Logistic regression defined predictive variables of high use patients. Multinomial Logistic Model assigned each patient to a package of care. RESULTS: The sample's socio-demographic characteristics are similar, but variations exist between the different CPS. Patients were then divided into two groups, and the group with the highest use of resources was divided into three smaller groups, based on number and type of services provided. CONCLUSIONS: Our findings show how is possible to develop a cost predictive model to assign patients with a high use of resources to a group that can provide the right level of care. For these patients it might be possible to apply a prospective per-capita funding system based on packages of care.

A His-155 to Tyr polymorphism confers gain-of-function to the human P2X7 receptor of human leukemic lymphocytes.

The P2X(7)R is an ATP-gated cation channel expressed in hemopoietic cells that participates in both cell proliferation and apoptosis. Expression and function of the P2X(7)R have been associated with the clinical course of patients affected by chronic lymphocytic leukemia (CLL). Functional variants causing loss-of-function of the P2X(7)R have been identified, namely, polymorphisms 1513A>C (E496A), 1729T>A (I568N), and 946G>A (R307Q). Here we investigated other nonsynonymous polymorphisms located either in the extracellular portion of the receptor, such as the 489C>T (H155Y) variant, or in the long cytoplasmic tail of the receptor, such as the 1068G>A (A348T), 1096C>G (T357S), and 1405A>G (Q460R) variants. P2X(7)R function was monitored by measuring ATP-induced Ca(2+) influx in PBL of patients affected by CLL and in recombinant human embryonic kidney (HEK) 293 cells stably transfected with each single P2X(7) allelic variant. Ca(2+) influx was markedly reduced in association with the 1513C allele, whereas variants located in the same intracellular domain, such as the 1068A, 1096G, or 1405G variants, were associated with a minor functional decrease. Significant Ca(2+) flux increase was observed in lymphocytes from CLL patients bearing the 489C/T and 489T/T genotypes in association with the 1513A/A genotype. Functional analysis in recombinant HEK293 cells expressing P2X(7)R confirmed an increased ATP-dependent activation of the P2X(7) 489T mutant with respect to the wild type receptor, as assessed by both by [Ca(2+)](i) influx and ethidium uptake experiments. These data identify the 489C>T as a gain-of-function polymorphism of the P2X(7)R.

Abnormalities of chromosomes 1p34-36, 4p16, 4q35, 9q11-32 and +7 represent novel recurrent cytogenetic rearrangements in chronic lymphocytic leukemia.

Karyotypes were studied in over 250 cases of CLL seen at our Institution and 12 cases with a previously undescribed chromosome abnormality were identified. Cytogenetic and clinicobiological features in these patients are described. Fluorescence in situ hybridization using probes for the detection of +12 and deletions of 13q14, 17p13, and 11q22-23 was performed. Hematologic and clinical data were reviewed and a review of the literature was performed. Twelve patients were found carrying the following aberrations in the stemline: abnormalities at 1p34 (n = 2), 4p16 (n = 2), 4q35 (n = 2), 9q11-32 (n = 4) and +7 (n = 2). Trisomy 12 was found in 3 cases, whereas no case carried 13q-, 11q-, 17p-. Our data showed that (i) aberrations involving 1p34 and 4p16 as isolated chromosome anomalies were preferentially associated with early stage disease; (ii) 4q35 anomalies were associated with a relatively aggressive disease, atypical morphology and with monoclonal gammopathy; (iii) rearrangements of 9q were characterized by atypical morphology and aggressive disease with splenic involvement; (iv) +7 be may associated with +12. 1p34-36; 4p16; 4q35; 9q and chromosome 7 represent novel recurrent rearranged sites in CLL, with a 0.5-3% incidence. Transformation in these patients seemingly occured through a cytogenetic route not involving the classical CLL-associated chromosome regions. These chromosome rearrangements may be associated with peculiar hematologic features.

Late appearance of the 11q22.3-23.1 deletion involving the ATM locus in B-cell chronic lymphocytic leukemia and related disorders. Clinico-biological significance.

BACKGROUND AND OBJECTIVES: Chromosome 11q22.3-23.1 deletions involving the ataxia-teleangiectasia mutated (ATM) locus (11q-/ATM+/-) are detected at diagnosis in 10-20% of cases of B-cell chronic lymphocytic leukemia (CLL) and are associated with a relatively aggressive disease. The aim of this study was to ascertain whether 11q-/ATM+/- may appear late during the course of the disease and to analyze its possible correlation with disease evolution. DESIGN AND METHODS: Eighty-two patients with CLL and related disorders, i.e. CLL/PL and prolymphocytic leukemia (PLL), without 11q- at diagnosis were sequentially ascertained at 1-2 year intervals by conventional cytogenetic analysis (CCA) and fluorescence in situ hybridization (FISH), using an ATM-specific probe. RESULTS: Eight patients acquired a submicroscopic 11q deletion 13-43 months after diagnosis: the diagnosis at presentation was CLL in 3 cases, CLL/PL in 3 cases and PLL in 2 cases. A 13q14 deletion preceded the development of 11q- in four patients; additional aberrations included +12 (three cases), 17p13 deletion and 6q21 deletion (one case each). The acquisition of the 11q deletion was more frequently found in those patients presenting with CLL/PL and PLL than typical CLL (p=0.0016) and with splenomegaly (p=0.003). Follow-up data showed that karyotype evolution (p=0.009) and cytological transformation (p<0.001) were associated with the acquisition of this cytogenetic lesion. The variables predicting for a shorter survival in this series included the 11q deletion (p=0.03), along with other classical clinicobiological parameters (performance status, advanced stage, splenomegaly, elevated serum beta2 microglobulin and lactate dehydrogenase levels. INTERPRETATION AND CONCLUSIONS: a) Submicroscopic 11q deletion involving the ATM locus may, in some instances, represent a secondary change in CLL, CLL/P and PLL, suggesting that sequential FISH analyses are necessary to detect this chromosome anomaly in some patients; b) the acquisition of 11q-/ATM deletion may play a role in determining cytological transformation and disease progression of CLL and related disorders.