Post-closure Cost Efficiency in Public Versus Private Landfills: The Case of Emilia-Romagna (Italy).

Waste management systems have developed in recent years toward the adoption of sustainable management principles and practices, such as circular economy, zero waste, resource efficiency, waste avoidance, re-use, and recycling. Nevertheless, landfills continue to be used for waste disposal despite their risks related to contamination and effects on urban development. Most research on landfills focuses on their operational and technical aspects, while the performance and cost efficiency in managing landfills is less commonly studied, especially their post-closure management. However, improving efficiency is very relevant in the context of scarce public sector resources. This paper, therefore, analyzes the efficiency of post-closure management of landfills. Drawing on agency and stewardship theories, we focus on the difference in efficiency between public and private management of post-closure landfills. We use a linear mixed regression model to analyze data from 2015 to 2018 relating to 54 landfills (79% of which are privately managed) in the Emilia-Romagna region of Italy. The results show that public management is more efficient than private management. Results contribute to defining drivers of cost and confirming a disparity in the performance of private and public management. Our results cast doubt on the assumption, which is prevalent in new public management theory, that private operators are more efficient than public ones. We conclude by highlighting that to reach efficiency, it is better to increase the effectiveness of regulation in terms of value for money, without pre-determined preferences for the type of management.

Biomonitoring of polycyclic aromatic hydrocarbons, heavy metals, and plasticizers residues: role of bees and honey as bioindicators of environmental contamination.

Polycyclic aromatic hydrocarbons (PAHs), heavy metals, and plasticizer residues are continuously released into the environment. The use of living organisms, such as Apis mellifera L. and honey, is advantageous as bioindicator of the environmental health status, instead of traditional monitoring methods, showing the ability to record spatial and temporal pollutant variations. The PAHs and heavy metal presence were determined in two sampling years (2017 and 2018) in five different locations in the Molise region (Italy), characterized by different pollution levels. During 2017, most PAHs in all samples were lower than limit of detection (LOD), while in 2018, their mean concentration in bee and honey samples was of 3 µg kg-1 and 35 µg kg-1, respectively. For heavy metals, lower values were detected in 2017 (Be, Cd, and V below LOD), while in 2018, the mean concentrations were higher, 138 µg kg-1 and 69 µg kg-1, in bees and honey, respectively. Honey has been used as indicator of the presence of phthalate esters and bisphenol A in the environment. The satisfactory results confirmed that both bees and honey are an important tool for environmental monitoring. The chemometric analysis highlighted the differences in terms of pollutant concentration and variability in the different areas, validating the suitability of these matrices as bioindicators.

Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era.

Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay. A retrospective analysis on 895 patients undergoing pulmonary lobectomy from January 2014 to December 2019 was performed. PAAL was defined as air leak lasting more than 5 days after lung surgery. Univariate analyses and logistic regressions were performed to identify the predictors of PAAL. A backward selection algorithm was used to identify the optimal set of predictors. The incidence of PAAL was 8.2% (74/895). Male gender (p=0.017), BMI (p<0.001), transient ischemic attack (p=0.031), FEV1 (p=0.018), lobectomy combined with adjacent subsegmentectomy (p=0.018), partial and extended pleural adhesions (p=0.033 and p=0.038, respectively) were identified as independent risk factors for PAAL through logistic regression. A weak positive correlation was found between video-assisted thoracic surgery (VATS) and PAAL following pulmonary lobectomy (p=0.100). PAAL was found to be associated with higher risk of postoperative morbidity (p=0.002) and with longer hospital stay (p<0.001). Both preoperative and intraoperative risk factors may be responsible for PAAL after pulmonary lobectomy. VATS does not appear to prevent this postoperative complication. An alveolar air leak lasting beyond 5 days after pulmonary lobectomy is associated with worse postoperative outcomes.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection.

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as "satisfied," while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery?

BACKGROUND: The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). METHODS: From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. RESULTS: Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041). CONCLUSIONS: MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered.