Translating knowledge into policy: Organizational model and minimum requirements for the implementation of a regional pancreas unit network.

Pancreatic and periampullary cancers pose significant challenges in oncological care due to their complexity and diagnostic difficulties. Global experiences underscore the crucial role of multidisciplinary collaboration and centralized care in improving patient outcomes in this context. Recognizing these challenges, Lombardy, Italy's most populous region, embarked on establishing pancreas units across its territory to enhance clinical outcomes and organizational efficiency. This initiative, driven by a multistakeholder approach involving the Lombardy Welfare Directorate, clinicians, and a patient association, emphasizes the centralization of complex care in high-volume hospitals, adopting a hub-and-spoke model and a multidisciplinary approach. This article outlines the process and criteria set forth for pancreas unit implementation, aiming to provide a structured framework for enhancing pancreatic cancer care. Central to this initiative is the establishment of structured criteria and minimal requirements, not only for surgery but also for other essential components of care, ensuring a comprehensive approach to pancreatic cancer management. The Lombardy model offers a structured framework for enhancing pancreatic cancer care, with potential applicability to other regions and countries seeking to improve their cancer care infrastructure.

Predicting natural arsenic enrichment in peat-bearing, alluvial and coastal depositional systems: A generalized model based on sequence stratigraphy.

Hazardously high concentrations of arsenic exceeding the threshold limits for soils and drinking waters have been widely reported from Quaternary sedimentary successions and shallow aquifers of alluvial and coastal lowlands worldwide, raising public health concerns due to potential human exposure to arsenic. A combined sedimentological and geochemical analysis of subsurface deposits, 2.5-50 m deep, from the SE Po Plain (Italy) documents a systematic tendency for naturally-occurring arsenic to accumulate in peat-rich layers, with concentrations invariably greater than maximum permissible levels. A total of 366 bulk sediment samples from 40 cores that penetrated peat-bearing deposits were analysed by X-ray fluorescence. Arsenic concentrations associated with 7 peat-free lithofacies associations (fluvial-channel, levee/crevasse, floodplain, swamp, lagoon/bay, beach-barrier, and offshore/prodelta) exhibit background values invariably below threshold levels (<20 mg/kg). In contrast, total arsenic contents from peaty clay and peat showed 2-6 times larger As accumulation. A total of 204 near-surface (0-2.5 m) samples from modern alluvial and coastal depositional environments exhibit the same trends as their deeper counterparts, total arsenic peaking at peat horizons above the threshold values for contaminated soils. The arsenic-bearing, peat-rich Quaternary successions of the Po Plain accumulated under persisting reducing conditions in wetlands of backstepping estuarine and prograding deltaic depositional environments during the Early-Middle Holocene sea-level rise and subsequent stillstand. Contamination of the Holocene and underlying Pleistocene aquifer systems likely occurred through the release of As by microbially-mediated reductive dissolution. Using high-resolution sequence-stratigraphic concepts, we document that the Late Pleistocene-Holocene lithofacies architecture dictates the subsurface distribution of As. The "wetland trajectory", i.e. the path taken by the landward/seaward shift of peat-rich depositional environments during the Holocene, may help predict spatial patterns of natural As distribution, delineating the highest As-hazard zones and providing a realistic view of aquifer contamination even in unknown areas.

Sediment core analysis using artificial intelligence.

Subsurface stratigraphic modeling is crucial for a variety of environmental, societal, and economic challenges. However, the need for specific sedimentological skills in sediment core analysis may constitute a limitation. Methods based on Machine Learning and Deep Learning can play a central role in automatizing this time-consuming procedure. In this work, using a robust dataset of high-resolution digital images from continuous sediment cores of Holocene age that reflect a wide spectrum of continental to shallow-marine depositional environments, we outline a novel deep-learning-based approach to perform automatic semantic segmentation directly on core images, leveraging the power of convolutional neural networks. To optimize the interpretation process and maximize scientific value, we use six sedimentary facies associations as target classes in lieu of ineffective classification methods based uniquely on lithology. We propose an automated model that can rapidly characterize sediment cores, allowing immediate guidance for stratigraphic correlation and subsurface reconstructions.

A territory-wide opportunistic, hospital-based HCV screening in the general population from northern Italy: The 1969-1989 birth-cohort.

BACKGROUND AND AIM: The World Health Organization (WHO) goal of Hepatitis C Virus (HCV) elimination by 2030 rose awareness about the need of screening plans, worldwide. In Italy, graduated screening starting from people born in 1969-1989 might be the most-effective strategy. We performed an opportunistic HCV screening study in the general population attending health facilities in Lombardy region, Northern Italy. METHODS: This is a prospective, multicenter, territory-wide, opportunistic study supported by the Regional Government of Lombardy, Italy. Between June 2022 and December 2022, all subjects born in 1969-1989, hospitalized or accessing blood collection centres were offered anti-HCV and HCV-RNA tests. Patients with known anti-HCV positivity and/or previous anti-HCV treatment were excluded. Demographic features were uploaded into a regional web-based platform. RESULTS: In total, 120 193 individuals were screened in 75 centres. Mean age was 44 (±6) years, 65.2% were females, 83.7% were tested at blood collection centres. Anti-HCV tested positive in 604 (0.50%) subjects: mean age 47 (±5), 51.1% females. HCV seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and in- vs. outpatients (p = 0.0009). HCV-RNA was detectable in 125 out of 441 (28.3%) anti-HCV positive subjects. Actively infected patients were 46 (±6) years old, mainly males (56.8%). The overall prevalence of active HCV infection was 0.10%, higher in elderly (p = 0.0003) and in in-patients (p = 0.0007). Among 93 HCV-RNA positive patients, the median age was 48 years, 58% males, 62% Italian born, median HCV-RNA levels were 6,1 log IU/mL, liver stiffness measurement (LSM) values 5.5 (3.1-29.9) kPa and ALT levels 48 U/L. CONCLUSIONS: The prevalence of active HCV infection in the 1969-1989 population attending health facilities in Lombardy was low. Most viremic patients were Italian-born, with mild liver disease but high-HCV-RNA levels. Due to the higher prevalence in the elderly, the extension of such opportunistic screening programs to lower birth cohorts would be warranted.

The potential of digital health records for public health research, policy, and practice: the case of the Lombardy Region Data Warehouse.

Digital health records can provide advantages to healthcare practice, policy, and research. Several countries have established population-based digitalised data collection, integrated through data linkage techniques. In Lombardy (Italy), a regional population-based registry was established in the 2000s. It collects data from the social and health sector, anonymised immediately after their acquisition and restructured in a single repository. Data can be used for public health interest, planning, monitoring, services evaluation, and research. Indeed, data can also be provided to universities and other scientific institutes. The availability of such data enables to explore the epidemiology of infectious, chronic, and rare diseases. Thus, epidemiological research can support policymakers to tackle public health threats. However, analysis of electronic health records comes along with several challenges, including data inaccuracy, incompleteness, and biases. Researchers should take into consideration limits and barriers related to quality of data. Moreover, health data use must adhere to the national and European privacy legislation, at times limiting the potential of data integration. Therefore, even if big data drives innovation and scientific knowledge, ethical issues regarding privacy should be considered in public debate.

Geochemical anomalies of potentially hazardous elements reflect catchment geology: An example from the Tyrrhenian coast of Italy.

Assessing soil contamination by hazardous metals and estimating the extent to which metal concentrations in surficial sediments may pose risks to human health are increasingly important environmental issues. An integrated sedimentological and geochemical study of 57 Holocene beach sands from the shallow subsurface (120-130 cm depth) of the heavily urbanized Tyrrhenian Sea coast of Italy (Tuscany and adjacent coastal stretches) allowed a remarkable compositional heterogeneity to be identified as a function of spatial variations in riverine sediment supply and alongshore sediment dispersal patterns. Concentrations of Cr, Ni, and As exceeding maximum permissible limits for recreational/industrial sites (150 mg/kg, 120 mg/kg, and 20 mg/kg, respectively) reveal spatial trends that fit the petrography of modern beach sands and closely reflect the geology of river catchments, thus indicating a geogenic origin. Extremely high concentrations of Cr (and Ni), even 10 times greater than threshold values, are interpreted to reflect sediment supply from river catchments rich in ultramafic rocks (ophiolite sequences of Cecina and Campiglia areas), with subsequent transport via the longshore drift. On the other hand, high As concentrations in the Campiglia region and along the southern stretch of coast reflect leaching of felsic volcanic and plutonic parent rocks and hydrothermal products related to the Tuscan and Roman magmatic provinces cropping out in the Fiora, Albegna, and Cornia river catchments. This study shows that coastal sediment derived from particular source rocks is likely to contain potentially harmful metals in predictable proportions, which may easily exceed maximum allowable concentrations. Assessing spatial distribution of such metals based on catchment geology and sediment transport pathways may help separate natural concentrations from the anthropogenic contribution, providing a valuable source of information for appropriate remediation strategies and management options.

Stratigraphic signatures of mass extinctions: ecological and sedimentary determinants.

Stratigraphic patterns of last occurrences (LOs) of fossil taxa potentially fingerprint mass extinctions and delineate rates and geometries of those events. Although empirical studies of mass extinctions recognize that random sampling causes LOs to occur earlier than the time of extinction (Signor-Lipps effect), sequence stratigraphic controls on the position of LOs are rarely considered. By tracing stratigraphic ranges of extant mollusc species preserved in the Holocene succession of the Po coastal plain (Italy), we demonstrated that, if mass extinction took place today, complex but entirely false extinction patterns would be recorded regionally due to shifts in local community composition and non-random variation in the abundance of skeletal remains, both controlled by relative sea-level changes. Consequently, rather than following an apparent gradual pattern expected from the Signor-Lipps effect, LOs concentrated within intervals of stratigraphic condensation and strong facies shifts mimicking sudden extinction pulses. Methods assuming uniform recovery potential of fossils falsely supported stepwise extinction patterns among studied species and systematically underestimated their stratigraphic ranges. Such effects of stratigraphic architecture, co-produced by ecological, sedimentary and taphonomic processes, can easily confound interpretations of the timing, duration and selectivity of mass extinction events. Our results highlight the necessity of accounting for palaeoenvironmental and sequence stratigraphic context when inferring extinction dynamics from the fossil record.

Origin of VC-only plumes from naturally enhanced dechlorination in a peat-rich hydrogeologic setting.

The occurrence of vinyl chloride (VC) is often a main concern at sites contaminated with chlorinated solvents due to its high degree of toxicity and carcinogenicity. VC occurrence in aquifers is most often related to the degradation of higher chlorinated ethenes or ethanes and it is generally detected in plumes along with parent contaminants. However, specific combination of stratigraphic, hydrogeologic and geochemical conditions can enhance the degradation of parents and lead to the formation of plumes almost entirely composed of VC (i.e. VC-only plumes). This paper investigates the causes of VC-only plumes in the aquifers below the city of Ferrara (northern Italy) by combining multiple lines of evidence. The City of Ferrara is located on an alluvial lowland, built by the River Po, and is made up of alternating unconsolidated sandy aquifer and silt-clay aquitard deposits of fluvial origin. This region has been strongly impacted by prior industrial activities, with the occurrence of chlorinated compounds at several sites. VC-only plumes with uncertain source location were found at two contaminated sites. The source zone of a third plume composed of chloroethenes from PCE to VC was investigated for high resolution depositional facies architecture and contaminant distribution (contaminant concentration and Compound Specific Isotope Analysis - CSIA). The investigation suggested that degradation of PCE and TCE takes place during contaminant migration through peat-rich (swamp) layers related to the Holocene transgression, which locally act as a "reactor" for stimulating degradation with the accumulation of VC in the strongly reducing environment of the peat. Regional-scale stratigraphic architecture showed the ubiquitous occurrence of swamp layers at distinct stratigraphic levels in the investigated system and their apparent linkage to the in situ creation of the VC-only plumes.

Differential responses of marine communities to natural and anthropogenic changes.

Responses of ecosystems to environmental changes vary greatly across habitats, organisms and observational scales. The Quaternary fossil record of the Po Basin demonstrates that marine communities of the northern Adriatic re-emerged unchanged following the most recent glaciation, which lasted approximately 100,000 years. The Late Pleistocene and Holocene interglacial ecosystems were both dominated by the same species, species turnover rates approximated predictions of resampling models of a homogeneous system, and comparable bathymetric gradients in species composition, sample-level diversity, dominance and specimen abundance were observed in both time intervals. The interglacial Adriatic ecosystems appear to have been impervious to natural climate change either owing to their persistence during those long-term perturbations or their resilient recovery during interglacial phases of climate oscillations. By contrast, present-day communities of the northern Adriatic differ notably from their Holocene counterparts. The recent ecosystem shift stands in contrast to the long-term endurance of interglacial communities in face of climate-driven environmental changes.

Fingerprinting sedimentary and soil units by their natural metal contents: a new approach to assess metal contamination.

One of the major issues when assessing soil contamination by inorganic substances is reliable determination of natural metal concentrations. Through integrated sedimentological, pedological and geochemical analyses of 1414 (topsoil/subsoil) samples from 707 sampling stations in the southern Po Plain (Italy), we document that the natural distribution of five potentially toxic metals (Cr, Ni, Cu, Zn and Pb) can be spatially predicted as a function of three major factors: source-rock composition, grain size variability and degree of soil weathering. Thirteen genetic and functional soil units (GFUs), each reflecting a unique combination of these three variables, are fingerprinted by distinctive geochemical signatures. Where sediment is supplied by ultramafic (ophiolite-rich) sources, the natural contents of Cr and Ni in soils almost invariably exceed the Italian threshold limits designated for contaminated lands (150 mg/kg and 120 mg/kg, respectively), with median values around twice the maximum permissible levels (345 mg/kg for Cr and 207 mg/kg for Ni in GFU B5). The original provenance signal is commonly confounded by soil texture, with general tendency toward higher metal concentrations in the finest-grained fractions. Once reliable natural metal concentrations in soils are established, the anthropogenic contribution can be promptly assessed by calculating metal enrichments in topsoil samples. The use of combined sedimentological and pedological criteria to fingerprint GFU geochemical composition is presented here as a new approach to enhance predictability of natural metal contents, with obvious positive feedbacks for legislative purposes and environmental protection. Particularly, natural metal concentrations inferred directly from a new type of pedogeochemical map, built according to the international guideline ISO 19258, are proposed as an efficient alternative to the pre-determined threshold values for soil contamination commonly established by the national regulations.