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Background: A significant proportion of patients with positive multiparametric magnetic resonance imaging (mpMRI; Prostate Imaging-Reporting and Data System [PI-RADS] scores of 3-5) have negative biopsy results., Objective: To systematically assess all prostate-specific antigen density (PSAD) values and identify an appropriate cutoff for identification of patients with positive mpMRI who could potentially avoid biopsy on the basis of their PI-RADS score., Design, Setting, and Participants: The study included a cohort of 1341 patients with positive mpMRI who underwent combined targeted and systematic biopsies., Outcome Measurements and Statistical Analysis: Multivariable logistic regression analysis (MVA) was used to assess the association between PSAD and the risk of clinically significant prostate cancer (csPCa, grade group ≥2) after adjusting for confounders. We used locally weighted scatterplot smoothing to explore csPCa risk according to PSAD and PI-RADS scores. PSAD utility was observed only for patients with PI-RADS 3 lesions, so we plotted the effect of each PSAD value as a cutoff for this subgroup in terms of biopsies saved, csPCa cases missed, and clinically insignificant PCa (ciPCa, grade group 1) cases not detected., Results and Limitations: Overall, 667 (50%) csPCa cases were identified. On MVA, PSAD independently predicted csPCa (odds ratio 1.57; p < 0.001). For PI-RADS ≥4 lesions, the csPCa risk was ≥40% regardless of PSAD. Conversely, among patients with PI-RADS 3 lesions, csPCa risk ranged from 0% to 60% according to PSAD values, and a PSAD cutoff of 0.10 ng/ml/cm 3 corresponded to a threshold probability of 10% for csPCa. Using this PSAD cutoff for patients with PI-RADS 3 lesions would have saved 32% of biopsies, missed 7% of csPCa cases, and avoided detection of 34% of ciPCa cases. Limitations include selection bias and the high experience of the radiologists and urologists involved., Conclusions: Patients with PI-RADS ≥4 lesions should undergo prostate biopsy regardless of their PSAD, while PSAD should be used to stratify patients with PI-RADS 3 lesions. Using a threshold probability of 10% for csPCa, our data suggest that the appropriate strategy is to avoid biopsy in patients with PI-RADS 3 lesions and PSAD <0.10 ng/ml/cm 3 . Our results also provide information to help in tailoring an appropriate strategy for every patient with positive mpMRI findings., Patient Summary: We investigated whether a cutoff value for PSAD (prostate-specific antigen density) could identify patients with suspicious prostate lesions on MRI (magnetic resonance imaging) who could avoid biopsy according to the PI-RADS score for their scan. We found that patients with PI-RADS ≥4 should undergo prostate biopsy regardless of their PSAD. A PSAD cutoff of 0.10 should be used to stratify patients with PI-RADS 3., (Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: The professional quality of life (ProQOL) is a fundamental aspect of the care providers' working life and plays an important role in monitoring their mental health status and wellbeing. The objective of this study is to explore the level of ProQOL among the Emergency Operating Center workers in the Italian context and to examine the role of both stressors and coping strategies. Health workers from an Italian 118 Emergency Operating Center participated into the research., Methods: A preliminary cross-sectional study has been performed., Results: The survey's response rate was 72.04% (n = 67). Results found that Stressors are positively correlated with Burnout and Compassion Fatigue whereas Compassion Satisfaction has a positive correlation with the Task-oriented coping strategy and with the Emotion-oriented strategy., Conclusions: In conclusion, it is pivotal to implement strategies and solutions that can enhance the levels of satisfaction of Emergency Operating Center workers in order to improve patients care and organizational outcomes.

The co-digestion of a variable amount of fruit and vegetable waste in a waste mixed sludge digester was investigated using a pilot scale apparatus. The organic loading rate (OLR) was increased from 1.46 kg VS/m(3) day to 2.8 kg VS/m(3) day. The hydraulic retention time was reduced from 14 days to about 10 days. Specific bio-methane production increased from about 90 NL/kg VS to the maximum value of about 430 NL/kg VS when OLR was increased from 1.46 kg VS/m(3) day to 2.1 kg VS/m(3) day. A higher OLR caused an excessive reduction in the hydraulic retention time, enhancing microorganism wash out. Process stability evaluated by the total volatile fatty acids concentration (mg/l) to the alkalinity buffer capacity (eq. mg/l CaCO3) ratio (i.e. FOS/TAC) criterion was <0.1 indicating high stability for OLR <2.46 kg VS/m(3 )day. For higher OLR, FOS/TAC increased rapidly. Residual phytotoxicty of the digestate evaluated by the germination index (GI) (%) was quite constant for OLR<2.46 kg VS/m(3)day, which is lower than the 60% limit, indicating an acceptable toxicity level for crops. For OLR>2.46 kg VS/m(3) day, GI decreased rapidly. This corresponding trend between FOS/TAC and GI was further investigated by the definition of the GI ratio (GIR) parameter. Comparison between GIR and FOS/TAC suggests that GI could be a suitable criterion for evaluating process stability., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The mechanically sorted dry fraction (MSDF) and Fines (<20mm) arising from the mechanical biological treatment of residual municipal solid waste (RMSW) contains respectively about 11% w/w each of recyclable and recoverable materials. Processing a large sample of MSDF in an existing full-scale mechanical sorting facility equipped with near infrared and 2-3 dimensional selectors led to the extraction of about 6% w/w of recyclables with respect to the RMSW weight. Maximum selection efficiency was achieved for metals, about 98% w/w, whereas it was lower for Waste Electrical and Electronic Equipment (WEEE), about 2% w/w. After a simulated lab scale soil washing treatment it was possible to extract about 2% w/w of inert exploitable substances recoverable as construction materials, with respect to the amount of RMSW. The passing curve showed that inert materials were mainly sand with a particle size ranging from 0.063 to 2mm. Leaching tests showed quite low heavy metal concentrations with the exception of the particles retained by the 0.5mm sieve. A minimum pollutant concentration was in the leachate from the 10 and 20mm particle size fractions., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The bioreactor environment for the mechanically sorted organic fraction (MSOF) of residual municipal solid waste was simulated for a period of 300 days. A closed-loop system was implemented for analysing the leachate purification process due to its recirculation through MSOF. Maximum concentrations of Cu, Zn and Ni in the leachate were about 60, 20 and 15 mg L(-1), whereas Pb and Cr were about 5.5 and 7 mg L(-1). About 60 days from the start of recirculation these concentrations dropped to < 1 mg L(-1). Chemical (COD) and biological oxygen demand (BOD5) dropped, respectively, by about 50 and 80%, achieving a COD-to-BOD5 ratio > 7. Volatile fatty acids, which were about 10 g L(-1), fell to about 3.5 g L(-1) whereas biomethane production was about 34 NL kg TS(-1). As expected, recirculation under strictly anaerobic conditions gave minor benefits in reducing nitrogen and ammonium which reached final concentrations of about 4 and 3.8 g L(-1), respectively.