P816Mortality during weekend admission for takotsubo syndrome: a national cross sectional large scale study

Background

Higher mortality rates in patients admitted for an acute myocardial infarction during weekends has been recently confirmed. Differences in staffing and in lower rates of early reperfusion therapy are thought to affect outcomes of these patients particularly of those presenting with ST segment elevation. Patients affected by Takotsubo cardiomyopathy may present themselves mimicking those affected by heart attack and are frequently admitted with supposed diagnosis of acute coronary syndrome. No data is available about influence on mortality in relation to the time of admission among patients with Takotsubo cardiomyopathy.

Rationale

The aim of this study is to assess the effect on mortality due to admission during weekend among patients discharged with diagnosis of Takotsubo cardiomyopathy.

Methods

We retrieved administrative data about every admission to National Healthcare System hospitals in Italy between 2009 and 2017 with final diagnosis of Takotsubo cardiomyopathy according to ICD9-CM classification of diseases (code 429.83). Date of admission was used to determine the weekend (Saturday and Sunday) or weekdays exposure (Monday to Friday). The primary outcome was in-hospital mortality. Demographical characteristics of patients (age and sex) were included in a multivariate logistic regression analysis. We also analyzed the impact of weekend admission on time to coronary angiography and on length of hospital staying. Analyses were performed using Stata 13.0.

Results

A total of 10,861 Takotsubo admissions were identified. Mean age was 70.7 years and 91.7% were women. The in-hospital mortality was 2.21%. We found that there was no significant increase in the risk of death among patients admitted during weekends (OR 1.07; 95% CI 0.77–1.44). The variability explained by the model was of 4.2% (pseudo R-squared 0.042). Men have a higher risk of mortality as compared to women (OR 2.37, 95% C.I 1.69–3.33). Patients admitted during weekend tends to stay in hospital longer, but they do not seem to wait more days to get a coronary angiography.

Conclusions

At variance with patients with ST elevated acute myocardial infarction, subjects admitted during weekends for Takotsubo cardiomyopathy did not show an excess of in-hospital mortality in comparison to those admitted during week days.

Lamivudine-based maintenance antiretroviral therapies in patients living with HIV-1 with suppressed HIV RNA: derivation of a predictive score for virological failure

OBJECTIVES

Two-drug antiretroviral regimens based on lamivudine (3TC) plus either a protease inhibitor (PI) or dolutegravir (DTG) are becoming increasingly popular in switch strategies. Our goal was to derive a predictive score for virological failure (VF).

METHODS

We retrospectively analysed data for a cohort of 587 virologically suppressed (HIV RNA < 37 HIV-1 RNA copies/mL), adult (≥ 18 years old) patients starting lamivudine plus either a boosted PI or dolutegravir. Predictors of VF (defined as a single HIV RNA measurement ≥ 1000 copies/mL or two consecutive HIV RNA measurements ≥ 50 copies/mL) were identified using a multivariate Cox regression model. A 'weighted' score was assigned to each variable associated with VF; the discriminative power of the score obtained was expressed as the area under the receiver-operator characteristic curve (ROC-AUC).

RESULTS

During a median 2 years of follow-up time, 35 VFs occurred; predictors of VF were baseline residual HIV RNA between 20 and 36 copies/mL, African ethnicity, ≥ 10 therapeutic lines, the presence of at least one resistance-associated mutation (RAM) for resistance to current drugs (excluding M184V), a non-B viral subtype and a baseline CD4 count < 200 cells/μL. A score of 2 was assigned to non-B viral subtype, 3 to residual viraemia ≥ 20 copies/mL, ≥ 10 previous therapeutic lines and African ethnicity, 4 to baseline CD4 count < 200 cells/μL, and 7 to the presence of at least one RAM (excluding M184V). The ROC-AUC was 0.67 (95% confidence interval 0.57-0.77).

CONCLUSIONS

The presence of at least one RAM, higher residual viraemia and African ethnicity were among the major predictors of VF in our cohort. Studies with larger sample sizes are warranted to improve the predictive value of the derived score.

Constraining the Spin-Dependent WIMP-Nucleon Cross Sections with XENON1T

We report the first experimental results on spin-dependent elastic weakly interacting massive particle (WIMP) nucleon scattering from the XENON1T dark matter search experiment. The analysis uses the full ton year exposure of XENON1T to constrain the spin-dependent proton-only and neutron-only cases. No significant signal excess is observed, and a profile likelihood ratio analysis is used to set exclusion limits on the WIMP-nucleon interactions. This includes the most stringent constraint to date on the WIMP-neutron cross section, with a minimum of 6.3×10^{-42}  cm^{2} at 30  GeV/c^{2} and 90% confidence level. The results are compared with those from collider searches and used to exclude new parameter space in an isoscalar theory with an axial-vector mediator.

First Results on the Scalar WIMP-Pion Coupling, Using the XENON1T Experiment

We present first results on the scalar coupling of weakly interacting massive particles (WIMPs) to pions from 1  t yr of exposure with the XENON1T experiment. This interaction is generated when the WIMP couples to a virtual pion exchanged between the nucleons in a nucleus. In contrast to most nonrelativistic operators, these pion-exchange currents can be coherently enhanced by the total number of nucleons and therefore may dominate in scenarios where spin-independent WIMP-nucleon interactions are suppressed. Moreover, for natural values of the couplings, they dominate over the spin-dependent channel due to their coherence in the nucleus. Using the signal model of this new WIMP-pion channel, no significant excess is found, leading to an upper limit cross section of 6.4×10^{-46}  cm^{2} (90% confidence level) at 30  GeV/c^{2} WIMP mass.

Prevalence and determinants of resistance mutations in HIV-1-infected patients exposed to integrase inhibitors in a large Italian cohort

OBJECTIVES

The aim of the study was to analyse the prevalence of integrase resistance mutations in integrase strand transfer inhibitor (INSTI)-experienced HIV-1-infected patients and its predictors.

METHODS

We selected HIV-1 integrase sequences from the Antiviral Response Cohort Analysis (ARCA) database, derived from INSTI-experienced patients between 2008 and 2017. Differences in the prevalence of resistance to raltegravir (RAL), elvitegravir (EVG) and dolutegravir (DTG) were assessed by χ² test and predictors of resistance were analysed by logistic regression.

RESULTS

We included 462 genotypes from INSTI-exposed individuals: 356 'INSTI-failing' patients and 106 'previously INSTI-exposed' patients (obtained a median of 42 weeks after INSTI discontinuation [interquartile range (IQR) 17-110 weeks]). Overall, at least low-level resistance (LLR) to any INSTI (Stanford 8.5 algorithm) was detected in 198 (42.9%) cases. The most frequent INSTI resistance mutation was N155H, followed by Q148H/K/R, G140A/C/S, E138A/K/T and Y143C/H/R. Y143R and E138A were more prevalent in viral subtype B versus non-B [5.2 versus 1.5%, respectively (P = 0.04), and 3.1 versus 0%, respectively (P = 0.02)]. Overall, the Q148H/K/R plus G140A/C/S and/or E138A/K/T pattern, defining an intermediate level of resistance to DTG, was detected in 70 (15%) cases. Independent predictors of at least LLR to any INSTI were current use versus past use of INSTIs, a lower genotypic sensitivity score (GSS) for contemporary antiretroviral drugs used, and having an integrase sequence obtained in calendar year 2016 as compared to 2008-2009.

CONCLUSIONS

The results support integrase resistance testing in INSTI-experienced patients. Emergence of INSTI resistance is facilitated by the reduced genetic barrier of the regimen as a consequence of resistance to companion drugs. However, INSTI resistance may become undetectable by standard population sequencing upon INSTI discontinuation.

Development of the Decannulation Prediction Tool in Patients With Dysphagia After Acquired Brain Injury

OBJECTIVES

Patients with acquired brain injuries (ABIs) often need tracheostomy because of dysphagia. However, many of them may recover over time and be eventually decannulated during post-acute rehabilitation. We developed the Decannulation Prediction Tool (DecaPreT) to identify, early in the post-acute course, patients with ABIs who can be safely decannulated.

DESIGN

Nonconcurrent cohort study.

SETTING AND PARTICIPANTS

Patients with ABI, as well as with dysphagia and tracheostomy, were retrospectively selected from the database of a neurorehabilitation unit in Correggio, Reggio Emilia, Italy.

MEASURES

Potential bivariate predictors of decannulation were screened from variables collected on admission during clinical examination, conducted by an expert speech therapist. Multivariable prediction was then obtained in 2 separate random subsamples to develop and validate the logistic regression model of the DecaPreT.

RESULTS

Of 463 patients with ABI (mean age 52.2 years) selected, 73.0% could be safely decannulated before discharge. After bivariate screening, multivariable predictors of decannulation were identified in the development subsample and confirmed in the validation subsample, each with its odds ratio and 95% confidence interval as follows: age tertile (1.77, 1.08-2.89; P = .024), no saliva aspiration (3.89, 1.73-8.64; P = .001), pathogenesis of ABI (trauma vs other causes vs stroke vs anoxia: 2.23, 1.41-3.54; P = .001), no vegetative status (8.47; 2.91-24.63; P < .001), and coughing score (voluntary and reflex vs voluntary vs reflex vs neither voluntary nor reflex cough: 2.62, 1.70-4.05; P < .001). In the validation subsample, the predicting equation obtained an area under the receiver operating characteristics curve of 0.836.

IMPLICATIONS

The DecaPreT predicts safe decannulation in patients with dysphagia and tracheostomy, using simple clinical variables detected early in the post-acute phase of ABI. The tool can help clinicians choose timing and intensity of rehabilitation interventions and plan discharge.

Dark Matter Search Results from a One Ton-Year Exposure of XENON1T

We report on a search for weakly interacting massive particles (WIMPs) using 278.8 days of data collected with the XENON1T experiment at LNGS. XENON1T utilizes a liquid xenon time projection chamber with a fiducial mass of (1.30±0.01)  ton, resulting in a 1.0 ton yr exposure. The energy region of interest, [1.4,10.6]  keV_{ee} ([4.9,40.9] keV_{nr}), exhibits an ultralow electron recoil background rate of [82_{-3}^{+5}(syst)±3(stat)]  events/(ton yr keV_{ee}). No significant excess over background is found, and a profile likelihood analysis parametrized in spatial and energy dimensions excludes new parameter space for the WIMP-nucleon spin-independent elastic scatter cross section for WIMP masses above 6  GeV/c^{2}, with a minimum of 4.1×10^{-47}  cm^{2} at 30  GeV/c^{2} and a 90% confidence level.

Restatement of Lymphography in Childhood: Experience with 413 Consecutive Patients in Ten Years

From January 1969 to June 1978, 413 children under 15 years of age underwent lymphography at the Istituto Nazionale Tumori of Milan. Successful lymphatic cannulation was accomplished in 97.7% (769/787) of the sites where it was attempted. No major or permanent complications were encountered. In those children undergoing biopsy of opacified lymph nodes, the lymphographic-histologic correlation was 94.5% (104/110). This study has shown that lymphography in childhood can be as readily performed as in the adult and that its diagnostic accuracy is acceptable. As in adults, it is useful in treatment planning, evaluating results of therapy, and detecting a recurrent tumor.

The Evolving Role of Radiation Therapy in the Optimal Multimodality Treatment of Childhood Cancer

Childhood cancer is rare, representing only 1% of the total cancer problem. Of children diagnosed with cancer today, more than 70% are predicted to be long-term survivors. Essentially all pediatric cancers are treated by interdigitating radiation with surgical resection and systemic chemotherapy. The use of irradiation, important to achieve high rates of disease local control, must be always balanced against late effects specifically related to this treatment modality, principally growth retardation and second tumors induction. Using neuroblastoma, Wilms’ tumor and rhabdomyosarcoma as examples, the advances in the optimal multimodality treatment of childhood cancer and the evolution of the role of radiation therapy are discussed.

Cisplatin (P) versus Cyclophosphamide, Adriamycin and Cisplatin (CAP) for Stage III-IV Epithelial Ovarian Carcinoma: A Prospective Randomized Trial

In 1982 a randomized trial was started to compare a cisplatin-containing polychemotherapy (CAP: cyclophosphamide - CPA 750 mg/m2, adriamycin - ADM 50 mg/m2, cisplatin - P 50 mg/m2 on day 1 every 21 days) with full-dose cisplatin as single agent (P 60 mg/m2/day on days 1 and 2 every 28 days) in 44 patients undergoing exploratory laparotomy or debulking sugery for stage III-IV epithelial ovarian carcinoma with residual disease > 5 cm. The response was evaluated at second-look surgery with random biopsies and peritoneal washing. On the basis of the final results the authors underline some data which, although merely indicative (because of the small number of patients) appear to be worth considering since they are in accordance with the latest reports: a) similar response rate (CR+PR=47%) to first-line treatment in the two groups; b) the CAP treatment may achieve a longer median duration of CRs than the P treatment (20 versus 11 months); c) overall survival seems similar in the two groups of patients (19 versus 18 months), whereas the survival of CRs seems longer in the CAP treated patients (> 32 versus 25 months). The authors also discuss some observations on a possible salvage therapy.

Combination of Mitomycin C + Etoposide in Advanced Gastric Carcinoma

In June 1981 the authors activated a trial to evaluate the therapeutic effectiveness of the combination mitomycin C (MMC) + etoposide (VP 16) in previously untreated gastric carcinoma with measurable neoplastic lesions. Drugs were administered according to the following schedule: MMC, 12 mg/m2 i.v. day 1, + VP 16, 150-200 mg/m2 orally days 2, 3, 4, 22, 23, 24 every 6 weeks. The response rate (CR+PR) was 16.7 %, which is not higher than that obtained when MMC and VP 16 are used as single agents. Overall median survival (8 months) was similar to that reported in the recent literature with combination chemotherapy.

Cobalt Therapy in the Treatment of Carcinoma of the Oropharynx

A clinical retrospective evaluation of 177 cases of carcinoma of the oropharynx treated with Cobalt therapy from 1959 to 1965 has been made. The analysis of long term results has shown that Cobalt therapy alone does not satisfactorily control carcinomas of oropharynx. In fact, less than 30% of the patients is still alive after 3 years. Survival is directly affected by the local extent of disease since, while the 5-year survival of Tl and T2 cases is respectively 26.8% and 21.5%, only 6.5% of patients with T3 carcinomas is still alive after 5 years. Particularly disappointing is the survival rate in cases with mono- or bilateral involvement of neck nodes, since none of these cases are alive 2 years after the initial therapy. In 69.4% of the cases, treatment failure has to be attributed to minimal response or early recurrence of primary tumor, while lymph node relapses have been observed in more than 25% of the cases. To allow a detailed clinical evaluation of the results, the different regions of the oropharynx should be considered separatly, since differences in clinical evolution of various carcinomas would call for a different therapeutic approach. The results of this study in oropharyngeal carcinomas, indicate that improvement of long term results may only be obtained through a multidisciplinary therapeutic approach.

Soluble organic substances extracted from compost as amendments for Fenton-like oxidation of contaminated sites

The Fenton process is a well known treatment that proved to be effective for the remediation of sites contaminated by a wide range of organic pollutants. Its application to soil-water systems typically requires the addition of a stabilizer, in order to increase the H₂O₂ lifetime and thus the radius of influence of the treatment, and a chelating agent, aimed to extract and maintain in solution the iron present in the soil. However, as the use of these compounds has been debated for their environmental impact, efforts have been placed to test new "greener" amendments. Namely, in line with the concept of circular economy introduced by the European Council, in this study we have tested the use of humic acids extracted from compost as amendment in a Fenton-like process. These substances are of potential interest as can form complexes with metal ions and act as sorbents for hydrophobic organic compounds. Fenton-like lab-scale tests with the extracted humic acids were performed on a soil-water system artificially contaminated by chlorophenol. The obtained results were compared with those achieved applying commercial humic acids or traditional amendments (i.e. KH₂PO₄ or EDTA) used as reference. The humic acids extracted from compost allowed to achieve a H₂O₂ lifetime close to the one obtained with traditional stabilizing agent; besides, humic acids proved also effective in removing chlorophenol, with performance close to the one achieved using a traditional chelating agent. These findings hence suggest that the use of the humic acids extracted from wastes in a Fenton-like process could allow to replace at the same time the H₂O₂ stabilizer and the chelating agent.

Efficacy and tolerability of lamivudine plus dolutegravir as a switch strategy in a multicentre cohort of patients with suppressed HIV-1 replication

OBJECTIVES

We evaluated the efficacy and tolerability of lamivudine + dolutegravir in a cohort of HIV-1 infected, treatment-experienced patients with undetectable HIV-RNA.

METHODS

Time to treatment discontinuation (TD) and virological failure (VF) and their predictors were assessed in a multicenter cohort of HIV-1 infected patients, starting lamivudine + dolutegravir after reaching viral suppression. Secondary objective was the evaluation of changes in lipid profile, renal and immunological functions at week 48.

RESULTS

We enrolled 206 patients (72.8% male, with 51 years median age), who mainly switched their antiretroviral therapy for simplification (32.5%) or drug toxicity (54.5%). The estimated probability of maintaining virological suppression at 48 and 96 weeks was 98.2% and 95.1%, respectively. VF was independently predicted by cumulative time on antiretroviral therapy. The estimated probability of remaining on lamivudine plus dolutegravir was 86.7% and 80.5% at week 48 and 96, respectively. A significant improvement in immunological function (CD4 count and CD4/CD8 ratio) was evidenced at week 48, as well as a decrease in total cholesterol/HDL ratio, triglycerides and estimated glomerular filtration rate.

CONCLUSIONS

Lamivudine plus dolutegravir was effective in maintaining viral suppression in our cohort and led to an improvement in metabolic and immunologic functions.

Leaching behaviour of incineration bottom ash in a reuse scenario: 12years-field data vs. lab test results

Several types of standardized laboratory leaching tests have been developed during the past few decades to evaluate the leaching behaviour of waste materials as a function of different parameters, such as the pH of the eluate and the liquid to solid ratio. However, the link between the results of these tests and leaching data collected from the field (e.g. in disposal or reuse scenarios) is not always straightforward. In this work, we compare data obtained from an on-going large scale field trial, in which municipal solid waste incineration bottom ash is being tested as road sub-base material, with the results obtained from percolation column and pH-dependence laboratory leaching tests carried out on the bottom ash at the beginning of the test. The comparisons reported in this paper show that for soluble substances (e.g. Cl, K and SO₄), percolation column tests can provide a good indication of the release expected in the field with deviations usually within a factor of 3. For metals characterized by a solubility-controlled release, i.e. that depends more on eluate pH than the liquid to solid ratio applied, the results of pH-dependence tests describe more accurately the eluate concentration trends observed in the field with deviations that in most cases (around 80%) are within one order of magnitude (see e.g. Al and Cd). The differences between field and lab-scale data might be in part ascribed to the occurrence in the field of weathering reactions (e.g. carbonation) but also to microbial decomposition of organic matter that modifying leachate pH affect the solubility of several constituents (e.g. Ca, Ba and Cr). Besides, weathering reactions can result in enhanced adsorption of fulvic acids to iron/aluminum (hydr)oxides, leading to a decrease in the leaching of fulvic acids and hence of elements such as Cu, Ni and Pb that strongly depend on DOC leaching. Overall, this comparison shows that percolation column tests and pH-dependence tests can represent a reliable screening tool to derive data that could be employed in risk-based analysis or life cycle assessment (LCA) frameworks for evaluating potential environmental impacts deriving from specific disposal/reuse options for waste materials.

Non-Linear Dynamics in the Beat-to-Beat Variability of Sympathetic Activity in Decerebrate Cats

Non-linear interactions between low-frequency rhythms (0.1 Hz) of beat-to-beat variability series of sympathetic discharge and respiratory rhythm (0.3 Hz) are observed in decerebrate artificially ventilated cats. Simple graphical tools as Poincare and recurrence maps are used to detect, in a qualitative way, phase-locking phenomena. Non-parametric bispectral analysis is also carried out to quantify the degree of second-order coupling between oscillations at different frequencies.

An outbreak of acute hepatitis A among young adult men: clinical features and HIV coinfection rate from a large teaching hospital in Rome, Italy

OBJECTIVES

Italy is a low-incidence region for hepatitis A; however, during the last 2 years an increase in the incidence of hepatitis A virus (HAV) infection was reported in Europe. The aim of this study was to describe this recent outbreak.

METHODS

We retrospectively analysed all cases of acute hepatitis A diagnosed at our laboratory between January 2010 and June 2017. We evaluated the following variables at the time of diagnosis: sex, age, nationality, glutamic oxaloacetic transaminase (GOT/AST), glutamic pyruvic transaminase (GPT/ALT), bilirubin concentration, international normalized ratio (INR) and the presence or absence of anti-HIV-1/2 antibodies. Hospitalization was also considered. We analysed these parameters using the χ² test and Mann-Whitney U-test.

RESULTS

A total of 225 cases were analysed; 82.7% were in male patients, 94.2% were in Italians and the median age of the patients was 36.4 years. At diagnosis, the median GOT value was 306 U/L, the median GPT was 1389 U/L, and the median total bilirubin value was 5.88 mg/dL. Hospitalization was required for 142 patients, with a median duration of hospital stay of 8.5 days. In 2016-2017 we registered 141 cases, with a higher prevalence of male patients, higher GPT values and a higher prevalence of patients aged 20-39 years compared with older (2010-2015) cases. Homosexual intercourse was reported as the HAV risk factor in 70.2% of patients. HIV serology was available for 120 patients: 24 were HIV-positive, four of whom represented new diagnoses. HIV-positive patients showed lower bilirubin and GPT values and fewer hospitalizations than HIV-negative patients.

CONCLUSIONS

In 2016-2017, we saw a rise in the number of hepatitis A cases, with a higher prevalence of adult male patients. No significant differences regarding the prevalence of HIV coinfection emerged.

Heart Rate and Systolic Blood Pressure in Patients with Persistent Atrial Fibrillation

Background: During atrial fibrillation (AF), ventricular response is highly irregular and thus the beat-to-beat variation of blood pressure is increased because of variations in filling time and in contractility.

Objectives: Aim of the present study is to investigate the short-term dynamics of RR and SAP series in patients with AF, during rest and tilt, and after restoration of sinus rhythm. Methods: We computed symbolic sequences of the three phases, as they retain important features of the dynamics generated by the underlying control system. Then we applied a method based on rank order statistics of symbolic sequences to investigate the profile of different types of dynamics. The linguistic distance (range 0–1) between sequences represents a measure of similarity to assess whether the different physiological states are reflected on the dynamics of RR and SAP series.

Results: The distance between rest and tilt phases is 0.06 ± 0.02 for RR series, meaning they are very similar, while it is 0.21 ± 0.13 for SAP series, showing a difference in the short-term dynamics. RR mean decreases during tilt (738 ± 164 vs. 692 ± 152 ms, p < 0.05, rest vs. tilt), while mean SAP is not significantly different (101 ± 20 vs. 104 ± 14 mmHg, rest vs. tilt). Comparing AF and sinus rhythm, both RR and SAP series result different in terms of the computed distance.

Conclusions: SAP short-term dynamics seem to significantly change when comparing rest and tilt phases, while RR series remain unchanged. Moreover, RR mean but not SAP series significantly decreases during tilt.

Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study

BACKGROUND

Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department.

METHODS

A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI).

RESULTS

One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool.

CONCLUSIONS

The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.

A risk-based approach for assessing the recycling potential of an alkaline waste material as road sub-base filler material

In this work we present an integrated risk-based approach that can be used to evaluate the recycling potential of an alkaline waste material such as incineration bottom ash (BA) as unbound material for road sub-base construction. This approach, which is aimed at assessing potential risks to the groundwater resource (in terms of drinking water quality) and human health associated to the leaching of contaminants from the BA, couples the results of leaching tests for the estimation of source concentrations with the fate and transport models usually adopted in risk assessment procedures. The effects of weathering and of the type of leaching test employed to evaluate eluate concentrations were assessed by carrying out different simulations using the results of laboratory leaching tests. Specifically, pH-dependence and column percolation leaching tests were performed on freshly collected and 1-year naturally weathered BA samples produced from a grate-fired incineration plant treating Refuse Derived Fuel (RDF). To evaluate a broad span of possible scenario conditions, a Monte Carlo analysis was performed running 5000 simulations, randomly varying the input parameters within the ranges expected in the field. In nearly all the simulated conditions, the concentrations of contaminants in the groundwater for the specific type of BA tested in this work were well below EU and WHO drinking water quality criteria. Nevertheless, some caution should be paid in the case of the establishment of acidic conditions in the field since in this case the concentration of some elements (i.e. Al, Pb and Zn) is expected to exceed threshold values. In terms of risks to human health, for the considered utilization scenario the probability of exceeding the acceptable reference dose for water ingestion was usually less than 1% (except for Cr and Pb for which the probability was lower than 3.5% and 7%, respectively).

Recent Borexino results and perspectives of the SOX measurement

Borexino is a liquid scintillator detector sited underground in the Laboratori Nazionali del Gran Sasso (Italy). Its physics program, until the end of this year, is focussed on the study of solar neutrinos, in particular from the Beryllium, pp, pep and CNO fusion reactions. Knowing the reaction chains in the sun provides insights towards physics disciplines such as astrophysics (star physics, star formation, etc.), astroparticle and particle physics. Phase II started in 2011 and its aim is to improve the phase I results, in particular the measurements of the neutrino fluxes from the pep and CNO processes. By the end of this year, data taking from the sun will be over and a new project is scheduled to launch: Short distance Oscillation with boreXino (SOX), which uses a Cerium source for neutrinos (100÷150 kCi of activity) and aims to confirm or rule out the presence of sterile neutrinos. This particle is hypothesised to justify the reactor, Gallium and LSND anomalies found and can reject extensions to the standard model. The work presented is a summary of the solar neutrino results achieved so far, which lead not only to a precise study of the processes in the sun, but also to more Standard Model oriented measurements (such as the stability of the charge, i.e. the life time of the electron). Furthermore, the perspectives of the SOX program are discussed showing the experiment sensitivity to a fourth neutrino state covering almost entirely 3σ of the preferred region of the anomalous neutrino experiments, and additional applications of the detector such as the study of geo-neutrinos.

NbN superconducting nanonetwork fabricated using porous silicon templates and high-resolution electron beam lithography

Superconducting NbN nanonetworks with a very small number of interconnected nanowires, with diameter of the order of 4 nm, are fabricated combining a bottom-up (use of porous silicon nanotemplates) with a top-down technique (high-resolution electron beam lithography). The method is easy to control and allows the fabrication of devices, on a robust support, with electrical properties close to a one-dimensional superconductor that can be used fruitfully for novel applications.

First Dark Matter Search Results from the XENON1T Experiment

We report the first dark matter search results from XENON1T, a ∼2000-kg-target-mass dual-phase (liquid-gas) xenon time projection chamber in operation at the Laboratori Nazionali del Gran Sasso in Italy and the first ton-scale detector of this kind. The blinded search used 34.2 live days of data acquired between November 2016 and January 2017. Inside the (1042±12)-kg fiducial mass and in the [5,40]  keV_{nr} energy range of interest for weakly interacting massive particle (WIMP) dark matter searches, the electronic recoil background was (1.93±0.25)×10^{-4}  events/(kg×day×keV_{ee}), the lowest ever achieved in such a dark matter detector. A profile likelihood analysis shows that the data are consistent with the background-only hypothesis. We derive the most stringent exclusion limits on the spin-independent WIMP-nucleon interaction cross section for WIMP masses above 10  GeV/c^{2}, with a minimum of 7.7×10^{-47}  cm^{2} for 35-GeV/c^{2} WIMPs at 90% C.L.

Psychometric validation of the Italian Rehabilitation Complexity Scale-Extended version 13

In Italy, at present, a well-known problem is inhomogeneous provision of rehabilitative services, as stressed by MoH, requiring appropriate criteria and parameters to plan rehabilitation actions. According to the Italian National Rehabilitation Plan, Comorbidity, Disability and Clinical Complexity should be assessed to define the patient's real needs. However, to date, clinical complexity is still difficult to measure with shared and validated tools. The study aims to psychometrically validate the Italian Rehabilitation Complexity Scale-Extended v13 (RCS-E v13), in order to meet the guidelines requirements. An observational multicentre prospective cohort study, involving 8 intensive rehabilitation facilities of the Emilia-Romagna Region and 1712 in-patients, [823 male (48%) and 889 female (52%), mean age 68.34 years (95% CI 67.69-69.00 years)] showing neurological, orthopaedic and cardiological problems, was carried out. The construct and concurrent validity of the RCS-E v13 was confirmed through its correlation to Barthel Index (disability) and Cumulative Illness Rating Scale (comorbidity) and appropriate admission criteria (not yet published), respectively. Furthermore, the factor analysis indicated two different components ("Basic Care or Risk-Equipment" and "Medical-Nursing Needs and Therapy Disciplines") of the RCS-E v13. In conclusion, the Italian RCS-E v13 appears to be a useful tool to assess clinical complexity in the Italian rehab scenario case-mix and its psychometric validation may have an important clinical rehabilitation impact allowing the assessment of the rehabilitation needs considering all three dimensions (disability, comorbidity and clinical complexity) as required by the Guidelines and the inhomogeneity could be reduced.

Leaching behaviour of incineration bottom ash in a reuse scenario: 12years-field data vs. lab test results

Several types of standardized laboratory leaching tests have been developed during the past few decades to evaluate the leaching behaviour of waste materials as a function of different parameters, such as the pH of the eluate and the liquid to solid ratio. However, the link between the results of these tests and leaching data collected from the field (e.g. in disposal or reuse scenarios) is not always straightforward. In this work, we compare data obtained from an on-going large scale field trial, in which municipal solid waste incineration bottom ash is being tested as road sub-base material, with the results obtained from percolation column and pH-dependence laboratory leaching tests carried out on the bottom ash at the beginning of the test. The comparisons reported in this paper show that for soluble substances (e.g. Cl, K and SO₄), percolation column tests can provide a good indication of the release expected in the field with deviations usually within a factor of 3. For metals characterized by a solubility-controlled release, i.e. that depends more on eluate pH than the liquid to solid ratio applied, the results of pH-dependence tests describe more accurately the eluate concentration trends observed in the field with deviations that in most cases (around 80%) are within one order of magnitude (see e.g. Al and Cd). The differences between field and lab-scale data might be in part ascribed to the occurrence in the field of weathering reactions (e.g. carbonation) but also to microbial decomposition of organic matter that modifying leachate pH affect the solubility of several constituents (e.g. Ca, Ba and Cr). Besides, weathering reactions can result in enhanced adsorption of fulvic acids to iron/aluminum (hydr)oxides, leading to a decrease in the leaching of fulvic acids and hence of elements such as Cu, Ni and Pb that strongly depend on DOC leaching. Overall, this comparison shows that percolation column tests and pH-dependence tests can represent a reliable screening tool to derive data that could be employed in risk-based analysis or life cycle assessment (LCA) frameworks for evaluating potential environmental impacts deriving from specific disposal/reuse options for waste materials.

Balance of excitation and inhibition determines 1/f power spectrum in neuronal networks

The 1/f-like decay observed in the power spectrum of electro-physiological signals, along with scale-free statistics of the so-called neuronal avalanches, constitutes evidence of criticality in neuronal systems. Recent in vitro studies have shown that avalanche dynamics at criticality corresponds to some specific balance of excitation and inhibition, thus suggesting that this is a basic feature of the critical state of neuronal networks. In particular, a lack of inhibition significantly alters the temporal structure of the spontaneous avalanche activity and leads to an anomalous abundance of large avalanches. Here, we study the relationship between network inhibition and the scaling exponent β of the power spectral density (PSD) of avalanche activity in a neuronal network model inspired in Self-Organized Criticality. We find that this scaling exponent depends on the percentage of inhibitory synapses and tends to the value β = 1 for a percentage of about 30%. More specifically, β is close to 2, namely, Brownian noise, for purely excitatory networks and decreases towards values in the interval [1, 1.4] as the percentage of inhibitory synapses ranges between 20% and 30%, in agreement with experimental findings. These results indicate that the level of inhibition affects the frequency spectrum of resting brain activity and suggest the analysis of the PSD scaling behavior as a possible tool to study pathological conditions.

Analysis and interpretation of the leaching behaviour of waste thermal treatment bottom ash by batch and column tests

This paper investigates the leaching behaviour of specific types of waste thermal treatment bottom ash (BA) as a function of both pH and the liquid-to-solid ratio (L/S). Specifically, column percolation tests and different types of batch tests (including pH-dependence) were applied to BA produced by hospital waste incineration (HW-I), Refuse Derived Fuel (RDF) gasification (RDF-G) and RDF incineration (RDF-I). The results of these tests were interpreted applying an integrated graphical and modelling approach aimed at identifying the main mechanisms (solubility, availability or time-controlled dissolution and diffusion) governing the release of specific constituents from each type of BA. The final aim of this work was in fact to gain insight on the information that can be provided by the leaching tests applied, and hence on which ones may be more suitable to apply for assessing the leaching concentrations expected in the field. The results of the leaching tests showed that the three samples of analysed BA presented differences of orders of magnitude in their leaching behaviour, especially as a function of pH, but also in terms of the L/S. These were mainly related to the differences in mineralogy of the samples. In addition, for the same type of bottom ash, the comparison between the results of batch and percolation column tests, expressed in terms of cumulative release, showed that for some constituents (e.g. Mg for HW-I BA and Cu for RDF-G BA) differences of over one order of magnitude were obtained due to variations in pH and DOC release. Similarly, the eluate concentrations observed in the percolation tests, for most of the investigated elements, were not directly comparable with the results of the pH-dependence tests. In particular, in some cases the percolation test results showed eluate concentrations of some constituents (e.g. K and Ca in HW-I BA) of up to one order of magnitude higher than the values obtained from the pH-dependence experiments at the same pH value. This was attributed to a rapid washout from the column of the soluble phases present in the BA. In contrast, for other constituents (e.g. Mg and Ba for the RDF-G BA), especially at high L/S ratios, the concentrations in the column tests were of up to one order of magnitude lower than the solubility value, indicating release under non-equilibrium conditions. In these cases, batch pH-dependence tests should be preferred, since column tests results could underestimate the concentrations expected in the field.

An easy-to-use tool for the evaluation of leachate production at landfill sites

A simulation program for the evaluation of leachate generation at landfill sites is herein presented. The developed tool is based on a water balance model that accounts for all the key processes influencing leachate generation through analytical and empirical equations. After a short description of the tool, different simulations on four Italian landfill sites are shown. The obtained results revealed that when literature values were assumed for the unknown input parameters, the model provided a rough estimation of the leachate production measured in the field. In this case, indeed, the deviations between observed and predicted data appeared, in some cases, significant. Conversely, by performing a preliminary calibration for some of the unknown input parameters (e.g. initial moisture content of wastes, compression index), in nearly all cases the model performances significantly improved. These results although showed the potential capability of a water balance model to estimate the leachate production at landfill sites also highlighted the intrinsic limitation of a deterministic approach to accurately forecast the leachate production over time. Indeed, parameters such as the initial water content of incoming waste and the compression index, that have a great influence on the leachate production, may exhibit temporal variation due to seasonal changing of weather conditions (e.g. rainfall, air humidity) as well as to seasonal variability in the amount and type of specific waste fractions produced (e.g. yard waste, food, plastics) that make their prediction quite complicated. In this sense, we believe that a tool such as the one proposed in this work that requires a limited number of unknown parameters, can be easier handled to quantify the uncertainties.

Temporal correlations in neuronal avalanche occurrence

Ongoing cortical activity consists of sequences of synchronized bursts, named neuronal avalanches, whose size and duration are power law distributed. These features have been observed in a variety of systems and conditions, at all spatial scales, supporting scale invariance, universality and therefore criticality. However, the mechanisms leading to burst triggering, as well as the relationship between bursts and quiescence, are still unclear. The analysis of temporal correlations constitutes a major step towards a deeper understanding of burst dynamics. Here, we investigate the relation between avalanche sizes and quiet times, as well as between sizes of consecutive avalanches recorded in cortex slice cultures. We show that quiet times depend on the size of preceding avalanches and, at the same time, influence the size of the following one. Moreover we evidence that sizes of consecutive avalanches are correlated. In particular, we show that an avalanche tends to be larger or smaller than the following one for short or long time separation, respectively. Our analysis represents the first attempt to provide a quantitative estimate of correlations between activity and quiescence in the framework of neuronal avalanches and will help to enlighten the mechanisms underlying spontaneous activity.

LCA of management strategies for RDF incineration and gasification bottom ash based on experimental leaching data

The main characteristics and environmental properties of the bottom ash (BA) generated from thermal treatment of waste may vary significantly depending on the type of waste and thermal technology employed. Thus, to ensure that the strategies selected for the management of these residues do not cause adverse environmental impacts, the specific properties of BA, in particular its leaching behavior, should be taken into account. This study focuses on the evaluation of potential environmental impacts associated with two different management options for BA from thermal treatment of Refuse Derived Fuel (RDF): landfilling and recycling as a filler for road sub bases. Two types of thermal treatment were considered: incineration and gasification. Potential environmental impacts were evaluated by life-cycle assessment (LCA) using the EASETECH model. Both non-toxicity related impact categories (i.e. global warming and mineral abiotic resource depletion) and toxic impact categories (i.e. human toxicity and ecotoxicity) were assessed. The system boundaries included BA transport from the incineration/gasification plants to the landfills and road construction sites, leaching of potentially toxic metals from the BA, the avoided extraction, crushing, transport and leaching of virgin raw materials for the road scenarios, and material and energy consumption for the construction of the landfills. To provide a quantitative assessment of the leaching properties of the two types of BA, experimental leaching data were used to estimate the potential release from each of the two types of residues. Specific attention was placed on the sensitivity of leaching properties and the determination of emissions by leaching, including: leaching data selection, material properties and assumptions related to emission modeling. The LCA results showed that for both types of BA, landfilling was associated with the highest environmental impacts in the non-toxicity related categories. For the toxicity related categories, the two types of residues behaved differently. For incineration BA the contribution of metal leaching to the total impacts had a dominant role, with the highest environmental loads resulting for the road scenario. For the gasification BA, the opposite result was obtained, due to the lower release of contaminants observed for this material compared to incineration BA. Based on the results of this study, it may be concluded that, depending on the type of BA considered, its leaching behavior may significantly affect the results of a LCA regarding its management strategies.

The application of SRF vs. RDF classification and specifications to the material flows of two mechanical-biological treatment plants of Rome: Comparison and implications

This work assessed the quality in terms of solid recovered fuel (SRF) definitions of the dry light flow (until now indicated as refuse derived fuel, RDF), heavy rejects and stabilisation rejects, produced by two mechanical biological treatment plants of Rome (Italy). SRF classification and specifications were evaluated first on the basis of RDF historical characterisation methods and data and then applying the sampling and analytical methods laid down by the recently issued SRF standards. The results showed that the dry light flow presented a worst SRF class in terms of net calorific value applying the new methods compared to that obtained from RDF historical data (4 instead of 3). This lead to incompliance with end of waste criteria established by Italian legislation for SRF use as co-fuel in cement kilns and power plants. Furthermore, the metal contents of the dry light flow obtained applying SRF current methods proved to be considerably higher (although still meeting SRF specifications) compared to those resulting from historical data retrieved with RDF standard methods. These differences were not related to a decrease in the quality of the dry light flow produced in the mechanical-biological treatment plants but rather to the different sampling procedures set by the former RDF and current SRF standards. In particular, the shredding of the sample before quartering established by the latter methods ensures that also the finest waste fractions, characterised by higher moisture and metal contents, are included in the sample to be analysed, therefore affecting the composition and net calorific value of the waste. As for the reject flows, on the basis of their SRF classification and specification parameters, it was found that combined with the dry light flow they may present similar if not the same class codes as the latter alone, thus indicating that these material flows could be also treated in combustion plants instead of landfilled. In conclusion, the introduction of SRF definitions, classification and specification procedures, while not necessarily leading to an upgrade of the waste as co-fuel in cement kilns and power plants, may anyhow provide new possibilities for energy recovery from waste by increasing the types of mechanically treated waste flows that may be thermally treated.

Test of Electric Charge Conservation with Borexino

Borexino is a liquid scintillation detector located deep underground at the Laboratori Nazionali del Gran Sasso (LNGS, Italy). Thanks to the unmatched radio purity of the scintillator, and to the well understood detector response at low energy, a new limit on the stability of the electron for decay into a neutrino and a single monoenergetic photon was obtained. This new bound, τ≥6.6×10^{28}  yr at 90% C.L., is 2 orders of magnitude better than the previous limit.

Catalyst-free vapour-solid technique for deposition of Bi2Te3 and Bi2Se3 nanowires/nanobelts with topological insulator properties

We present a simple two-stage vapour-solid synthesis method for the growth of bismuth chalcogenide (Bi2Te3, Bi2Se3) topological insulator nanowires/nanobelts by using Bi2Se3 or Bi2Te3 powders as source materials. During the first stage of the synthesis process nanoplateteles, serving as "catalysts" for further nanowire/nanobelt growth, are formed. At a second stage of the synthesis, the introduction of a N2 flow at 35 Torr pressure in the chamber induces the formation of free standing nanowires/nanobelts. The synthesised nanostructures demonstrate a layered single-crystalline structure and Bi : Se and Bi : Te ratios 40 : 60 at% for both Bi2Se3 and Bi2Te3 nanowires/nanobelts. The presence of Shubnikov de Haas oscillations in the longitudinal magneto-resistance of the nanowires/nanobelts and their specific angular dependence confirms the existence of 2D topological surface states in the synthesised nanostructures.

Assessment of biogas production from MBT waste under different operating conditions

In this work, the influence of different operating conditions on the biogas production from mechanically-biologically treated (MBT) wastes is investigated. Specifically, different lab-scale anaerobic tests varying the water content (26-43% w/w up to 75% w/w), the temperature (from 20 to 25°C up to 55°C) and the amount of inoculum have been performed on waste samples collected from a full-scale Italian MBT plant. For each test, the gas generation yield and, where applicable, the first-order gas generation rates were determined. Nearly all tests were characterised by a quite long lag-phase. This result was mainly ascribed to the inhibition effects resulting from the high concentrations of volatile fatty acids (VFAs) and ammonia detected in the different stages of the experiments. Furthermore, water content was found as one of the key factor limiting the anaerobic biological process. Indeed, the experimental results showed that when the moisture was lower than 32% w/w, the methanogenic microbial activity was completely inhibited. For the higher water content tested (75% w/w), high values of accumulated gas volume (up to 150Nl/kgTS) and a relatively short time period to deplete the MBT waste gas generation capacity were observed. At these test conditions, the effect of temperature became evident, leading to gas generation rates of 0.007d(-1) at room temperature that increased to 0.03-0.05d(-1) at 37°C and to 0.04-0.11d(-1) at 55°C. Overall, the obtained results highlighted that the operative conditions can drastically affect the gas production from MBT wastes. This suggests that particular caution should be paid when using the results of lab-scale tests for the evaluation of long-term behaviour expected in the field where the boundary conditions change continuously and vary significantly depending on the climate, the landfill operative management strategies in place (e.g. leachate recirculation, waste disposal methods), the hydraulic characteristics of disposed waste, the presence and type of temporary and final cover systems.

Influence assessment of a lab-scale ripening process on the quality of mechanically-biologically treated MSW for possible recovery

In this study, the influence of an additional ripening process on the quality of mechanically-biologically treated MSW was evaluated in the prospective of recovering the end material, rather than landfilling. The biostabilised waste (BSW) coming from one of the MBT plants of Rome was therefore subjected to a ripening process in slightly aerated lab test cells. An in-depth investigation on the biological reactivity was performed by means of different types of tests (aerobic and anaerobic biological tests, as well as FT-IR spectroscopy method). A physical-chemical characterisation of waste samples progressively taken during the ripening phase was carried out, as well. In addition, the ripened BSW quality was assessed by comparing the characteristics of a compost sampled at the composting plant of Rome which treat source segregated organic wastes. Results showed that the additional ripening process allowed to obtain a better quality of the biostabilised waste, by achieving a much higher biological stability compared to BSW as-received and similar to that of the tested compost. An important finding was the lower heavy metals (Co, Cr, Cu, Ni, Pb and Zn) release in water phase at the end of the ripening compared to the as-received BSW, showing that metals were mainly bound to solid organic matter. As a result, the ripened waste, though not usable in agriculture as found for the compost sample, proved anyhow to be potentially suitable for land reclamation purposes, such as in landfills as cover material or mixed with degraded and contaminated soil for organic matter and nutrients supply and for metals recovery, respectively. In conclusion the study highlights the need to extend and optimise the biological treatment in the MBT facilities and opens the possibility to recover the output waste instead of landfilling.

Cross-cultural adaptation and preliminary test-retest reliability of the Italian version of the Complexity Rehabilitation Scale-Extended (13th version)

BACKGROUND

In Italy, the lack of appropriate use of intensive rehabilitative services is an acknowledged issue, as demonstrated by periodic epidemiological surveys. Rehabilitation activities are planned without considering the clinical complexity, known to be one of the most fundamental factors able to outline the real patients' needs on recently clinical practice rehabilitation guidelines. Alternative diagnostic systems become, therefore, necessary. For this reason, we would like to propose the Rehabilitation Complexity Scale - Extended version (RCS-E) within intensive rehabilitation units in Emilia Romagna.

AIM

This study aims at submitting an Italian translation, cross-cultural adaptation and preliminary reliability evaluation of the Rehabilitation Complexity Scale Extended (13th Version) (RCS-E).

DESIGN

Face validity and test-retest reliability.

SETTING

The study was conducted in three different rehabilitation units of the Emilia Romagna region, Northern Italy.

POPULATION

Ten expert physicians and 51 Intensive (code 56) rehabilitation in-patients were recruited.

METHODS

A cross-cultural adaptation of the scale was built from English into Italian, closely complying with international guidelines. Face validity and test-retest reliability were carried out to evaluate the comprehensibility and goodness of fit of the new scale.

RESULTS

An overall positive judgement was obtained with the face validity test. No significant differences were observed between the original and the adapted scale scoring. Internal consistency measured on 51 patients by Cronbach's alpha was 0.702 for the scale. The estimated SEM was 1.211. ICCconsistency was 0.702. Split-Half reliability and the Spearman-Brown prophecy were 0.633 and 0.775, respectively. Test-retest reliability of the RCS-E measured with ICCagreement was 0.903.

CONCLUSION

The adapted RCS-E provides a sensitive and reliable tool that appears to be suitable for measuring clinical complexity in Italian code 56 rehabilitation units. It is the first Italian version of the scale to be devised.

CLINICAL REHABILITATION IMPACT

Further statistical validation will assess the Italian RCS-E as a possible instrument for guiding the patients' assignment to the rehabilitation settings that best suit their specific needs. These preliminary data represent the first step through this purpose.

LCA of management strategies for RDF incineration and gasification bottom ash based on experimental leaching data

The main characteristics and environmental properties of the bottom ash (BA) generated from thermal treatment of waste may vary significantly depending on the type of waste and thermal technology employed. Thus, to ensure that the strategies selected for the management of these residues do not cause adverse environmental impacts, the specific properties of BA, in particular its leaching behavior, should be taken into account. This study focuses on the evaluation of potential environmental impacts associated with two different management options for BA from thermal treatment of Refuse Derived Fuel (RDF): landfilling and recycling as a filler for road sub bases. Two types of thermal treatment were considered: incineration and gasification. Potential environmental impacts were evaluated by life-cycle assessment (LCA) using the EASETECH model. Both non-toxicity related impact categories (i.e. global warming and mineral abiotic resource depletion) and toxic impact categories (i.e. human toxicity and ecotoxicity) were assessed. The system boundaries included BA transport from the incineration/gasification plants to the landfills and road construction sites, leaching of potentially toxic metals from the BA, the avoided extraction, crushing, transport and leaching of virgin raw materials for the road scenarios, and material and energy consumption for the construction of the landfills. To provide a quantitative assessment of the leaching properties of the two types of BA, experimental leaching data were used to estimate the potential release from each of the two types of residues. Specific attention was placed on the sensitivity of leaching properties and the determination of emissions by leaching, including: leaching data selection, material properties and assumptions related to emission modeling. The LCA results showed that for both types of BA, landfilling was associated with the highest environmental impacts in the non-toxicity related categories. For the toxicity related categories, the two types of residues behaved differently. For incineration BA the contribution of metal leaching to the total impacts had a dominant role, with the highest environmental loads resulting for the road scenario. For the gasification BA, the opposite result was obtained, due to the lower release of contaminants observed for this material compared to incineration BA. Based on the results of this study, it may be concluded that, depending on the type of BA considered, its leaching behavior may significantly affect the results of a LCA regarding its management strategies.