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Identifying immobilization mechanisms of potentially toxic elements (PTEs) is of paramount importance in the field application of solidification/stabilization. Traditionally, demanding and extensive experiments are required to better access the underlying retention mechanisms, which are usually challenging to quantify and clarify precisely. Herein, we present a geochemical model with parametric fitting techniques to reveal the solidification/stabilization of Pb-rich pyrite ash through conventional (ordinary Portland cement) and alternative (calcium aluminate cement) binders. We found that ettringite and calcium silicate hydrates exhibit strong affinities for Pb at alkaline conditions. When the hydration products are unable to stabilize all the soluble Pb in the system, part of the soluble Pb may be immobilized as Pb(OH) 2 . At acidic and neutral conditions, hematite from pyrite ash and newly-formed ferrihydrite are the main controlling factors of Pb, coupled with anglesite and cerussite precipitation. Thus, this work provides a much-needed complement to this widely-applied solid waste remediation technique for the development of more sustainable mixture formulations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The solidification/stabilization of phosphogypsum using cemented paste backfill (OCPB) provides a low-cost and alternative in-situ technique for recycling phosphogypsum stockpiles. But the OCPB is far from obtaining steady states in which the pollutants would redistribute as a response to dynamic environmental conditions. Further, the associated chemical interactions and the mineralogy information of the solubility-controlling phases of contaminants (fluorine and phosphorus) have not been thoroughly studied or fully understood. In this study, a framework coupling the chemical, mineralogical, and morphological analyses is used to determine the fluoride and phosphate retention mechanisms of immobilized OCPB. Then the pH-dependent leaching tests and numerical simulation is applied as a useful tool to identify the minerals controlling stabilized OCPB leaching behavior. The overall findings proved that aluminate-rich calcium silicate hydrates play an essential role in fluoride and phosphate retention. Both experimental and simulational acid neutralization and leaching curves indicate that the cementitious matrix works as a strong buffering material ensuring high pH conditions that are necessary for fluorine and phosphorus retention. Although discrepancies were observed in absolute fluorine and phosphorus leaching values at highly acidic conditions, the simulations are able to describe highly amphoteric leaching behavior. The simulation suggests that the aluminum species and calcium phosphates governed the solubility of fluorine and phosphorus, respectively. The results of this work would have implications for predicting the leaching behavior of OCPB in detrimental and multiple environments., (Copyright © 2022. Published by Elsevier Inc.)

Objective: No studies have explored the negative process of concordance: discordance in prescribing-medication-taking. This study provides a deeper understanding of discordance as a co-constructed process among patients and prescribers., Methods: To explore the question "what psychological and relational processes are involved when therapeutic discordance among prescribers and receivers occurs?" a constructivist Grounded Theory study was carried out through semi-structured interviews with patients and their medical doctors., Results: The final sample of our study was composed of 29 participants: 16 receivers and 13 prescribers. "Neglecting the relationship", the core category, shapes the therapeutic discordance and connects three main conceptual phases: signing a non-negotiating contract, acting alone, and establishing a superficial relationship., Conclusion: Our grounded theory conceptualization contributes to the concordance-related debate by evidencing the processes among prescribers and receivers in interwoven actions. It offers another dimension to how notions of compliance, adherence and concordance have been theorized to date., Practice Implications: More than one interaction with receivers is recommended. If there are hints that conflict potentially is compromising the relationship, prescribers should involve intermediaries. Setting aside for a moment, evidence-based justification for treatments and trying to understand prescribers' motivations may boost a positive change., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Cement-based stabilization is a widespread technique used for the treatment of contaminated soils. Despite its established application, the mechanisms involved in the stabilization of contaminants are not fully understood yet. This work aims to elucidate the fate of a real Pb contaminated soil amended with different binders, by studying Pb local environment prior and after the stabilization process. The study of a complex historically contaminated soil was coupled with the investigation of simplified artificial systems, developed to model Pb local structure in the unknown newly formed hybrid systems of soil and binders. The use of synchrotron-based element-specific X-ray absorption spectroscopy (XAS) permitted to probe the actual transformation of Pb environment in the real contaminated soil after the stabilization process. With the support of the model systems, we can propose as the main mechanism involved in Pb retention in sulfated soil treated with cement, the incorporation and/or adsorption of Pb on calcium silicate hydrates and ettringite., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Immunization is one of the most successful and cost-effective interventions to improve health outcomes. However, internationally, the phenomenon of parental vaccine hesitancy is increasing and presents a growing challenge for health professionals. This article summarizes the evidence surrounding childhood vaccine hesitancy from the perspective of parents., Study Design: We conducted a systematic review and meta-synthesis of qualitative studies., Methods: We searched for qualitative research articles in electronic databases from inception to March 2018. In addition, a manual search of the retrieved articles and their references was conducted to identify other potential articles. We used the Critical Appraisal Skills Programme to examine study validity, adequacy and potential applicability of the results. No articles were excluded for reasons of quality. By performing a meta-synthesis, we identified descriptive themes and, subsequently, the conceptual elements of vaccine hesitancy., Results: The review included 27 studies involving a total of 1557 parents who were hesitant about vaccinating their child. Five overarching categories were identified: (1) risk conceptualization; (2) mistrust towards vaccine-related institutions, pharmaceutical companies, researchers, health professionals and the information from media; (3) parental alternative health beliefs about childhood immunity, vaccine scheduling and the perceived toxicity of vaccinations; (4) philosophical views on parental responsibility; and (5) parents' information levels about vaccination., Conclusions: Healthcare providers need to approach this difficult situation considering that parents desire to do what they feel right for the child. Understanding the core elements of hesitancy will allow health professionals to adopt effective communication and behavioural strategies., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The application of an innovative solidification/stabilization (S/S) process was investigated for the remediation of Pb contaminated soil. The performance of Pb stabilization was evaluated by comparing the use of calcium aluminate cement (CAC) and an alkali activated metakaolin binder vs the Ordinary Portland Cement (OPC). The phase composition of the stabilized products was investigated by XRD and correlated to the internal microstructure obtained by SEM-EDX imaging. Leaching tests were performed to ascertain the effectiveness of the proposed binders in the S/S of the contaminated soil, and Pb release was evaluated for each binding system. The overall results proved that multiple mechanisms are involved in Pb retention and that key parameters regulating the stabilization performance are strongly dependent on the type of applied binder system. Pb was found to be associated to C-S-H in the case of OPC, whereas ettringite played a key role in the retention of this contaminant using the CAC binder. The use of a NaOH activated metakaolin resulted in almost total retention of Pb, despite a lack of solidification, highlighting the importance of pH in the regulation of the leaching behavior., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Retrieving the pristine chemical or isotopic composition of archaeological bones is of great interest for many studies aiming to reconstruct the past life of ancient populations (i.e. diet, mobility, palaeoenvironment, age). However, from the death of the individual onwards, bones undergo several taphonomic and diagenetic processes that cause the alteration of their microstructure and composition. A detailed study on bone diagenesis has the double purpose to assess the preservation state of archaeological bones and to understand the alteration pathways, thus providing evidence that may contribute to evaluate the reliability of the retrieved information. On these bases, this research aims to explore the effectiveness of Raman hyperspectral imaging to detect types, extent and spatial distribution of diagenetic alteration at the micro-scale level. An early-Holocene bone sample from the Al Khiday cemetery (Khartoum, Sudan) was here analysed. Parameters related to the collagen content, bioapatite crystallinity and structural carbonate content, and to the occurrence of secondary mineral phases were calculated from Raman spectra. The acquired data provided spatially-resolved information on both the preservation state of bone constituents and the diagenetic processes occurring during burial. Given the minimal sample preparation, the easy and fast data acquisition and the improvement of system configurations, micro-Raman spectroscopy can be extensively applied as a screening method on a large set of samples in order to characterise the preservation state of archaeological bones. This technique can be effectively applied to identify suitable and well preserved portions of the analysed sample on which perform further analyses., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Current evidence suggest that trabectedin is particularly effective in cells lacking functional homologous recombination repair mechanisms. A prospective phase II trial was designed to evaluate the activity of trabectedin in the treatment of recurrent ovarian cancer patients presenting BRCA mutation and/or BRCAness phenotype., Patients and Methods: A total of 100 patients with recurrent BRCA-mutated ovarian cancer and/or BRCAness phenotype (≥2 previous responses to platinum) were treated with trabectedin 1.3 mg/mq i.v. q 3 weeks. The activity of the drug with respect to BRCA mutational status and to a series of polymorphisms [single-nucleotide polymorphisms (SNPs)] involved in DNA gene repair was analyzed., Results: Ninety-four were evaluable for response; in the whole population, 4 complete and 33 partial responses were registered for an overall response rate (ORR) of 39.4. In the platinum-resistant (PR) and -sensitive (PS) population, an ORR of 31.2% and 47.8%, and an overall clinical benefit of 54.2% and 73.9%, respectively, were registered. In the whole series, the median progression-free survival (PFS) was 18 weeks and the median overall survival (OS) was 72 weeks; PS patients showed a more favorable PFS and OS compared with PR patients. BRCA gene mutational status was available in 69 patients. There was no difference in ORR, PFS and OS according to BRCA 1-2 status nor any association between SNPs of genes involved in DNA repair and NER machinery and response to trabectedin was reported., Conclusions: Our data prospectively confirmed that the signature of 'repeated platinum sensitivity' identifies patients highly responsive to trabectedin. In this setting, the activity of trabectedin seems comparable to what could be obtained using platinum compounds and the drug may represent a valuable alternative option in patients who present contraindication to receive platinum., Eudract Number: 2011-001298-17., (© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: To evaluate the incidence of false-negative (FN) sentinel lymph node (SLN) cases, their correlation with a series of clinico-pathologic parameters and their impact on adjuvant treatment indications and on clinical axillary relapse in the setting of a multicentric clinical trial comparing SLN biopsy with axillary lymph node dissection (ALND)., Methods: A series of 697 patients with primary breast cancer < or = 3 cm were randomized to SLN biopsy associated with ALND (ALND arm) or to SLN biopsy followed by ALND only if the SLN was metastatic (SLN arm). The FN SLN rate was assessed in the ALND arm. A series of 11 clinico-pathological parameters were tested for a possible association with FN results. The indications for adjuvant treatments were evaluated by considering both the FN nodal stages, as indicated by the SLN, and the true positive axillary status, as indicated by completion ALND. The occurrence of clinically evident axillary recurrences was evaluated in the two arms., Results: The FN rate was 16.7%. Of the clinico-pathologic parameters tested, only a tumour size < or = 2 cm and the presence of a single metastatic axillary node was significantly associated with a risk of FN (p = 0.033 and p = 0.018, respectively). The FN SLN would have led to different adjuvant therapy indications in 12/18 cases. At 56 months, no clinically evident axillary nodal recurrences were present in the ALND arm patients, whereas one case of axillary recurrence was detected in the SLN arm patients., Conclusions: FN SLN biopsy is not uncommon, especially in the presence of a small primary tumour with a single nodal metastasis. An FN finding can lead to less than optimal adjuvant treatment. However, the clinical impact of FN in terms of axillary recurrence at 56 months was minimal.

Purpose: To evaluate prophylactic salpingo-oophorectomy uptake and timing among BRCA1/2 mutation carriers in a cancer risk assessment program., Methods: Clinical records of female BRCA1/2 mutation carriers who received cancer genetic counseling between 1996 and 2003 were reviewed to determine the completion and the timing of prophylactic salpingo-oophorectomy. Logistic regression models evaluated associations between subject characteristics and surgery. Survival analysis methods were used to estimate the distribution of time to surgery., Results: Among 88 women, 70% underwent prophylactic salpingo-oophorectomy. Prophylactic salpingo-oophorectomy was associated with older age, white race, having children, and a family history of ovarian cancer. Many women waited more than 12 months to undergo surgery and some delayed by several years. Younger age and not having children were associated with delays to surgery., Conclusion: Prophylactic salpingo-ooporectomy is an acceptable risk reduction measure for many BRCA1/2 mutation carriers. Some women make this decision many years after genetic testing. Continued discussion of the risks and benefits of risk reduction options may facilitate the uptake of recommended risk reduction interventions among BRCA mutation carriers.

Background: Advanced biliary tract cancers have a poor prognosis. Gemcitabine (G) as a single agent or in combination represents an active treatment option. Systemic chemotherapy in hepatocellular carcinoma represents a palliative treatment. Gemcitabine in combination with Liposomal Doxorubicin (LD) may represent an active treatment option., Patients and Methods: Clinical trials for biliary and hepatic carcinoma have been reviewed., Results: We obtained RC (1 pt), RP (4 pts), SD (8 pts) and seven pts had PD (RR 25% and SD 40%). Our chemotherapy regimen was Gemcitabine 1000 mg/m(2) d 1 and 8, Liposomal Doxorubicin 30 mg d 1, q 28. Patients were 21 (17 M), aged 44 to 78 (median 63 yrs). Only in 8 pts we observed G 3-4 haematological toxicity, thrombocytopenia and neutropenia (7 G3, 1 G4).

Women in general have a 10% risk of developing breast cancer and a 2-3% chance of ovarian cancer in their life-times. Mutations in BRCA-1 and BRCA-2 are present in only a small portion (5-10%) of all breast cancers. Carriers of mutations in these genes have a greater risk of cancer, especially before menopause in the case of BRCA-1 carriers. In addition, their risk of contralateral breast cancer is significantly higher than for the general population (4.2-53% vs. 2%). The grade of contralateral tumours in these patients is more aggressive. BRCA-2 hereditary breast cancer seems more heterogeneous than the BRCA-1 phenotype, and not clearly different from sporadic forms. However, since 20-30% of carriers of BRCA mutations never develop breast or ovarian cancer, there must be other 'risk modifiers'. Survival is better for carriers of hereditary ovarian cancer. Patients with these mutations are referred for genetic counselling, a complex process which includes: an informative dialogue between the proband and the geneticist, drawing up a family history, informed consent, evaluation of risk, genetic testing and possible involvement of healthy family members., (Copyright 2001 Harcourt Publishers Ltd.)