Risk-based and sustainable approaches to remediation: Analysis and perspectives of the Italian and international context.

The management of contaminated areas is addressed at the international level with different regulatory instruments and approaches that can influence the selection of technologies, costs, and time for site recovery. The aim of this study was benchmarking the regulatory and technical approach to contaminated areas in both the Italian and international contexts, represented by eight European countries such as, among others, the United Kingdom, France, Germany, and the USA. An extensive international literature research was considered, including publications and reports by sector operators, legislators, and research groups, that enabled the identification of efficient and sustainable international practices and procedures for the contaminated site reclamation. Particular attention was paid to the status and costs of soil and groundwater remediation in Europe and in the United States. The outcomes of the study have shown that, from regulatory and administrative points of view, the remediation sector in Italy is among the most conservative, that is, more binding in the identification of contaminated sites and in the definition of remediation objectives. To reverse this trend and align it to the other countries that were the focus of this study, the concepts of mobility and/or bioavailability of contaminants, sustainability, and circular economy could be taken into account in the Italian administrative procedures. These concepts are currently only referred to in the Italian legislation but have not been yet made effectively applicable by codified procedures. In the Italian context, the conservative approach to site remediation may negatively affect the process of contaminated site reclamation and ecological transition. Further debate on the development of environmental regulations to align policies among the remediation stakeholders, particularly at the Italian and international regulatory level, is therefore needed. Integr Environ Assess Manag 2023;19:920-932. © 2022 SETAC.

Streptococcus lutetiensis neonatal meningitis with empyema.

Streptococcus lutetiensis has been known to cause sepsis in adults, but only one case regarding neonatal sepsis has been reported internationally, with no sequelae. We report the first case of neonatal bacteremia and meningitis with empyema caused by S. lutetiensis in the United States.

"Hi Mommy": Parental Preferences of Greetings by Medical Staff.

The therapeutic alliance between pediatricians and parents begins at the initial encounter. The manner in which pediatricians greet family members influences this relationship. This study evaluated whether parents are addressed using generic titles and investigated perceptions of parents regarding how they are addressed by medical staff. Written surveys of 137 parents of pediatric inpatients collected opinions about greetings during medical encounters. Parents were asked if they have been addressed as Mom/Dad/Mommy/Daddy during past medical encounters and which generic titles they would prefer. Using a Likert-type scale, the parents' perceptions of various salutations were assessed and compared. In this sample, 86% of parents were previously called Mom/Dad/Mommy/Daddy. Parents preferred to be addressed as Mom or Dad over other generic titles. Many disliked being addressed as Mommy/Daddy, Ma'am/Sir, or without a name, suggesting that providers should avoid the use of these salutations.

Arterial stiffness, lipoprotein particle size, and lipoprotein particle concentration in children with type 1 diabetes.

OBJECTIVE: To determine if lipoprotein particle abnormalities correlate with arterial stiffness in children with type 1 diabetes (T1D). STUDY DESIGN: In this case-control study, we evaluated 70 children, 35 with T1D and 35 controls, ages 10-18 years, matched for age, sex, race, and BMI. Arterial stiffness was assessed by radial tonometry (AI75) and blood was collected for lipoprotein subclass analysis. RESULTS: T1D subjects had increased AI75, decreased small LDL particle concentration (P = 0.0067), increased large LDL particle concentration (P = 0.007), increased large HDL particle concentration (P = 0.0012), increased mean LDL particle size (P = 0.0028), and increased mean HDL particle size (P < 0.0001) compared to controls. No significant correlations were found between lipoprotein subclasses and arterial stiffness in T1D subjects. CONCLUSIONS: T1D subjects have increased arterial stiffness when compared to controls, despite a less pro-atherogenic lipoprotein profile, indicating the need to identify other risk factors that correlate with arterial stiffness in T1D youth.

Evaluation of the presentation of systemic onset juvenile rheumatoid arthritis: data from the Pennsylvania Systemic Onset Juvenile Arthritis Registry (PASOJAR).

OBJECTIVE: To characterize the initial clinical and laboratory features of patients with systemic onset juvenile rheumatoid arthritis (soJRA) through a Web-based registry. METHODS: Patients diagnosed with soJRA in the last 15 years at 3 medical centers in Pennsylvania were identified. Data were collected retrospectively using a Web-based interface in compliance with patient privacy standards. Inferential statistics were used to compare features of patients with and without macrophage activation syndrome. RESULTS: We identified 136 patients; 88% of patients presented with arthritis (8% mono-, 45% oligo-, 47% polyarticular). The most common joints involved were the knee (68% of patients with arthritis), wrist (68%), and ankle (57%). The International League of Associations for Rheumatology criteria for systemic juvenile idiopathic arthritis (SJIA) identified only 30% of patients at presentation. CONCLUSION: We successfully characterized the presenting features of a relatively rare disease, soJRA, through the use of a Web-based registry. Current classification criteria for SJIA may not be particularly sensitive for diagnosis at presentation.

Pulmonary nodules associated with Gemella bacteremia: CT findings in two children with osteosarcoma.

Gemella morbillorum and Gemella haemolysans are normal oral flora that can also be pathogenic. We report 2 cases of adolescents with osteosarcoma who developed multiple pulmonary nodules associated with Gemella bacteremia. These nodules mimicked metastatic disease. To our knowledge, this manifestation of Gemella infection has not been previously reported. In the setting of malignancy, infectious pulmonary nodules must be distinguished from metastatic nodules in order to treat appropriately.